Pence Kelley- Contract - Laserfiche WebLink

Home Browse Search

. ! ~~ . Exhibit'C' FORM OF PROPOSAL Page 4 of 13 ~ _ _.. _ _ _ ars«s 00131-4 ~EBARMENT AND SUSPENSION CERTIFlCATION (LOWER TIER COVEREO TRANSACTION) (To be submitted wfth a bid o~ Offer exoeedt~g the small pur+chase th~+eshold for Federal ass~ance ProB~~ a~rtiY $100~000.) The Prospec~tve low~er tier partidpa~t (Oftero~ certifies. by submission of this Offer. that neither ~~ ffs 'p~indp~' as defined at 49 C.F.R. § 29.105~P) ~ P~'~~Y debamed. suspended, ProPosed fo~' debannent, dedaned k~ible~ or voluntarily exduded from partidpaHon i~ thts Vansadion by arry Federal departrnerrt or agency. ~ ff the Prospec~)ve lowe~ tter partidpant (Offero~ is unable to certtfy to the statemeM above. it shali attach art expla~atbn. and Indicate that It has done~ so~ bY P~~9 an x in the foilowi~g space _._. THE BIDDER OR OFFEROR~. p nP ~_~~~-~P~ l,v' ~ CERTIFIES OR AFFlRMS THE TRUTHFUWESS AND ACCURACY OF EACH STATEMENT OF tTS CERTtFtCAT10N AND EXPtANATtON, IF ANY. IN ADD1110N~ THE BIDDER OR OFFEROR UNDERSTANDS ANO AGREES THAT THE PROVISIONS OF 31 U.S.C s801 ET SEQ. APPLY TO THIS CERTIFlCATfON AND EXPI.ANATION~ IF ANY. . Signature of the Bidder or Of~eror's Autho~ize~Official . ;#; Terry Kelly, V. P. Name and Title of the Bidder w OPFerors Autho~ized Offidal ~ /4 /q9 Date LOBBYtNG CERT(FlCATtON ~;;:~.~~'>~`~=~ (ro ee ~ed wttn a wd or otre~ e~ooe~ng a~oo,ooo.~ The Bidder or Offeror oertifies, to fhe best ks knowledge and bettef. fhat: 1. No Federal appropdated funds have been patd o~ wtli be paid by o~ on behaif of the ~. ~~Y P~~ ~' ~n9 0~' attemptinp to i~lue~roe an officer or empioyee of the U.~S.~ ~~~~Y• a Member of fhe U.S. Cottg~+ess, en offic~er or emP~oy~ee Co~. a'sn employee of a Memba' of the U.S. Congtess in t~ntlec~ion wittt the aw~dG~p of any Fede~al oo~, the maldng of any Federal g~ant, the making of any Federal loan. the eote~ir~g k~to of a~y cooperatlve ag~+eemertt, a~d the extension, conttnuation~ ~+enewal~ amendmertt, or modification theneof. 2 - If a~y fu~ds ~ than Federal approp~iated tunds have bee~ paid o~ wpl be p~id to .any Pe~on for matdng bblrying oartacts to e~ offioer oc employee of am agency. a Membec of Congressrgn a~' or employee of Cong~+ess. or an employee of a Member of Cong~ss In con~ection with fhls Fede~al contrac~. grant, loan~ or coopet~We agt+eemertt, the u~i9ned s~ail oompide and submit Standard Fortn - W., `Otscaasure Form to Report Lobbyin9: in ev~rdanoe w~h its Ins~uctlon~ as amended by'Govemmertt Wide Guidance for New R~ctions on Lobbying; 61 Fed. Reg. .141 S(1H 9/96) ~ 3. ~ u~9~d ~ ~equtre tt~at the la~guage of th~s certification be induded in the award documerrts for aii subawa~ds at ali tiers (indudt~g subco~rtrads, sub8ratrts~ and o~ntracts under'9~s. loans. and oooperative a9~) and that all subrec:ipiertts shall certify and disGose accordingly. Thts certification is a mate~fai~~epreserttation of fact upon which ~ reliance was ptaced when this transadton was made or enter~ed irtto. Subm(ssion of this certtfication shall be subject to a dvii penalty of not tess than 510.000 and not more than ~100,000 for each such failure. "