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0 <br />Page: 38 <br />ATTACHMENT VI <br />CERTIFICATION REGARDING DEBARMENT, SUSPENSION & OTHER <br />INELIGIBILITY & VOLUNTARY EXCLUSION <br />The undersigned, duly authorized representative of <br />hereby certifies or affirms that: <br />1) Neither it nor its principals is presently debarred, suspended, proposed for <br />debarment, declared ineligible, or voluntarily excluded from participation in this <br />transaction by any Federal department or agency; and <br />2) That the contents of any statements submitted on or with this certification are <br />true and accurate, and understands that the provisions of 31 U.S.C. §§ 3801 et. <br />se~. are applicable thereto. <br />(Signature) (Attorney's Signature) <br />(Typed or Printed Title of <br />Authorized Official) <br />(Date) <br />OR <br />The undersigned, duly authorized representative of <br />hereby certifies or affirms that: <br />1) It is unable to certify that neither it nor its principals is presently debarred, <br />suspended, proposed for debarment, declared ineligible, or voluntarily excluded <br />from participation in this transaction by any Federal department or agency, and <br />has attached an explanation of this inability to this certification; and <br />2) That the contents of any statements submitted on or with this certification are <br />true and accurate, and understands that the provisions of 31 U.S.C. §§ 3801 gt. <br />se~c . are applicable thereto. <br />(Signature) <br />(Typed or Printed Title of <br />Authorized Representative) <br />(Attorney's Signatu~e) <br />(Date) <br />Attachment(s) [If required] <br />S:\9\Certification Re Debarment etc. for Bid Forms <br />