WPC  77WPC >?d~A?:@4?Z(L=0?!0=R<(R^oRZ1T7>K  (  (Untitled)'3,, , ,   UB ) 3    *    d +    d ,    d /0ghjklmnopqrstuvwxyz{|}~P* * c:\inf42\forms\ad1048.wpf c:\inf41\phuong\ad1048.wpfUS&& &&   >?df eh Terminal 1 ! d !  d      Terminal eb Arial " ! 2     d    Arial ev Times New Roman  ! 2 F  d    Times New Roman ? Ad A{?:z jZ c:\inf41\forest\data\ AD1048.DBFhistory   i)OrgzName  A   h ORGZNAMEA i'AwdNum  A   h AWDNUMA i(NmTitle      h NMTITLE  i%Sign      h SIGN i&Sign2      h SIGN2  i%Date     h DATE ?4@d @}?Z(~ ^ 2 U.S. DEPARTMENT OF AGRICULTURE F !"#                             P  &&    r  2o Certification Regarding Debarment, Suspension, Ineligibility  2{ and Voluntary Exclusion - Lower Tier Covered Transactions F !"#                             P  &&    6    & This certification is required by the regulations Implementing Executive Order 12549, Debarment and Suspension, 7 CFR Part  & 3017, Section 3017.510, Participants' responsibilities. The regulations were published as Part IV of the January 30, 1989,  & Federal Register (pages 4722-4733). Copies of the regulations may be obtained by contacting the Department of Agriculture  & agency with which this transaction originated. F !"#                             P      i, & (1)  !"#                             P  &    R & The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its  & principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily  & excluded from participation in this transaction by any Federal department or agency.  < !"#                             P  &    Wdh& } Organization Nameh ,OrgzName!"-./56 7#89:#;>?@ABCG                         P #      $      ' A  Y@$.,! *  < &< = &     cdh& } PR/Award Number or Project Nameh ,AwdNum!"-./5*6 7#89:#;>?@ABCG                         P #      $      ' A  Y@$.,! *  < <&< = <&     yL  } Name(s) and Title(s) of Authorized Representative(s) ,NmTitle!"-./56%7F89:F;>?@ABCG                         P #      $      '  A  Y@$.,! *  < &< = &     N# } Signature(s) Sign!"-./56-789:;>?@ABCG                         P #      $      '  A  Y@$.,! *  < &< = &     HT$& } Date ,Date!"- ./5C6.7 89: ;>?@ABCG                         P #      $      '   Y@$.,! *  < &&< = &&     2@HASVALUE (Date) and #UPDATONLY    Date  ~      7@datevalue (@datetext (Date, "%2-%1-%5"))   Date   %2-%1-%5  "  #  4@VALUE (@DATETEXT (Date,"%5"))<=29   Date   %5  "  x         p@SETVALUE (Date, @DATEVALUE (@CONCAT (@DATETEXT (Date,"%2-%1"),"-20",@DATETEXT (Date,"%5"))),TRUE)   Date   Date   %2-%1  "   -20   Date   %5  "      #       g. ,! & 1 ;F !"#                             P  &&    y.," & Form AD-1048 (1/92) ?; !"#                             P  &    p/ ,# d This form was electronically produced by Elite Federal Forms Inc. 2= !"#                             P  &     < 2 (BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS ON REVERSE) F !"#                             P  &&    i|,= & (2)  !"#                             P  &    0|R> & Where the prospective lower tier participant is unable to certify to any of the statements in this certification,  & such prospective participant shall attach an explanation to this proposal.  < !"#                             P  &    5# Sign2!"-K./5%6-789:;>?@ABCG                         P #      $      '  A  Y@$.,! *  < &< = &     ?=d =?!~ ,$ 2 Instructions for Certification F !"#                             P  &&    + & & 1. By signing and submitting this form, the prospective lower tier participant is providing the certification set out on the  & reverse side in accordance with these instructions.  F !"#                             P      g. ,6 & 2 ;F !"#                             P  &&    y.,7 & Form AD-1048 (1/92) :< !"#                             P  &    e(  B & 2. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction  & was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous  & certification, in addition to other remedies available to the Federal Government, the department or agency with which this  & transaction originated may pursue available remedies, including suspension and/or debarment.  F !"#                             P       C & 3. The prospective lower tier participant shall provide immediate written notice to the person to which this proposal is  & submitted if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or has  & become erroneous by reason changed circumstances. F !"#                             P      q0 D & 4. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant,"  & "person," "primary covered transaction," "principal," "proposal," and "voluntarily excluded," as used in this clause, have the  & meanings set out in the Definitions and Coverage sections of rules implementing Executive Order 12549. You may contact the  & person to which this proposal is submitted for assistance in obtaining a copy of those regulations. F !"#                             P      @J F & 5. The prospective lower tier participant agrees by submitting this form that, should the proposed covered transaction be  & entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended,  & declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department  & or agency with which this transaction originated. F !"#                             P      d G & 6. The prospective lower tier participant further agrees by submitting this form that it will include this clause titled  & "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions,"  & without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.  F !"#                             P      u H & 7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered  & transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it  & knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the  & eligibility of its principals. Each participant may, but is not required to, check the Nonprocurement List. $F !"#                             P        I & 8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to  & render in good faith the certification required by this clause. The knowledge and information of a participant is not required  & to exceed that which is normally possessed by a prudent in the ordinary course of business dealings. )F !"#                             P      # J & 9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transaction  & knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily  & excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the  & department or agency with which this transaction originated may pursue available remedies, including suspension and/or  & debarment. -F !"#                             P      ?e=d =<(defgh <@^o elite10.DLL IVALID FILLER This form was Designed by Elite Federal Forms and requires the Elite/Novell Filler! Call 410-647-9691 for more information. elite10.COM IVALID FILLER This form was Designed by Elite Federal Forms and requires the Elite/Novell Filler! Call 410-647-9691 for more information. WPIN$ELITE10FunctionSet,4.1 ^=ZZ