U.S. Department of the Interior <br /> Certifications Regarding Debarment, Suspension and <br /> Other Responsibility Matters, Drug-Free Workplace <br /> Requirements and Lobbying <br /> Persons signing this form should refer to the regulations referenced Certification Regazding Debarment, Suspension, Ineligibility and <br /> below for complete instructions: Voluntary Exclusion -Lower Tier Covered Transactions - (See <br /> Appendix B of Subpart D of 43 CFR Part 12.) <br /> Certification Regarding Debarment, Suspension, and Other <br /> Responsibility Matters -Primary Covered Transactions -The Certification Regarding Drug-Free Workplace Requirements -Alternate <br /> prospective primary participant further agrees by submitting this I. (Grantees Other Than Individuals) and Altemate II. (Grantees Who <br /> proposal that it will include the clause titled, "Certification are Individuals) - (See Appendix C of Subpart D of 43 CFR Part 12) <br /> Regarding Debarment, Suspension, Ineligibility and Voluntary <br /> Exclusion -Lower Tier Covered Transaction," provided by the Signature on this form provides for compliance with certification <br /> department or agency entering into this covered transaction, requirements under 43 CFR Parts 12 and 18. The certifications shall be <br /> without medification, in all lower tier covered transactions and in treated as a material representation of fact upon which reliance will be <br /> all solicitations for lower tier covered transactions. See below for placed when the Department of the Interior deternunes to award the <br /> PART A:Certification Regarding Debarment, Suspension, and Other Responsibility Matters - <br /> Primary Covered Transactions <br /> language to be used or use this form for certification and sign. (See covered transaction, grant, cooperative agreement or loan. <br /> <br /> • Appendix A of Subpart D of 43 CFR Part 12.) <br /> CHECK <br /> i/IF THIS CERTTFICATTON IS FOR A PRIMARY COVERED TRANSACTTONAND IS APPLICABLE. <br /> (1) The prospective primary participant certifies to the best of its knowledge and belief, that it and its principals: <br /> (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal department <br /> or agency; <br /> (b) Have not within athree-year period preceding this proposal been convicted of or had a civil judgment rendered against them for <br /> commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or perfornvng a public (Federal, State or <br /> local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, <br /> theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; <br /> (c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with <br /> commission of any of the offenses enumerated in paragraph (lxb) of this certification; and <br /> PART B:Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - <br /> Lower Tier Covered Transactions <br /> (d) Have not within athree-year period preceding this application/proposal had one or more public transactions (Federal, State or local) <br /> terminated for cause or default.(2) Where the prospective primary participant is unable to certify to any of the statements in this <br /> certification, such prospective participant shall attach an explanation to this proposal. <br /> CHECK IF THIS CERTIFICATION IS FOR A LOWER TIER COVERED TRANSACTIONAND IS APPLICABLE. <br /> (1) The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, <br /> proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. <br /> (2) Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall <br /> attach an explanation to this proposal. <br /> DI-2010 <br /> , June 1995 <br /> (Th1s form replaces DI-1953, DI-1954, <br /> DI-1955, DI-1956 and DI-1963) <br /> <br />