Additional Information for RFP #4 - Mandatory Federal Forms Packet 2-2024 - Form #130, Form #131, Form #132, Form #133

Description

Required State and Federal Forms Form #130 January 2022 Page 1 of 2 CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY, AND VOLUNTARY EXCLUSION LOWER TIER COVERED TRANSACTIONS (BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS BELOW) 1) The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals are presently debarred, suspended, proposed for disbarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. 2) 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. FSMC/Commercial Vendor Name Name and Title of Authorized FSMC/Commercial Vendor Representative Signature of Authorized Representative Date Required State and Federal Forms Form #130 February 2019 Page 2 of 2 Instructions for Certification By signing and submitting this form, the prospective lower tier participant is providing t h e certification in accordance with these instructions. 1. The certification in this document 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. 2. The prospective lower tier participant shall provide immediate written notice to the person to whom 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 of changed circumstances. 3. 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 the 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 (13 CFR Part 145). 4.