transportation.
APPENDIX A
CERTIFICATION OF PRIMARY PARTICIPANT - DEBARMENT
The CONTRACTOR certifies that it, its principals as defined in 49 CFR 29.995, or affiliates, as defined in
49 CFR 29.905:
1,
Are not presently debarred, suspended, purposed for debarment, declared ineligible, or
voluntarily excluded from covered transactions by any federal department or agency;
Have not within a three-year period preceding this proposal been convicted of or had a civil
judgment rendered against them for commission of fraud or a criminal offense in connection with
obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or
contract under a public transaction, violation of federal, or state antitrust statutes or commission
of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false
statements, or receiving stolen property:
Are not presently indicted for or otherwise criminally or civilly charged by a government entity
(federal, state, or local) with commission of any of the offenses enumerated in paragraph (2) of
this certification; and
Have not within a three-year period preceding this application/proposal had one or more public
transactions (federal, state or local) terminated for cause or default.
The CONTRACTOR is required to comply with 49 CFR 29, Subpart C and must include the requirement
to comply with 49 CFR 29, Subpart C in any lower tier covered transaction.
The CONTRACTOR certifies or affirms the truthfulness and accuracy of the contents of the statements
submitted on or with this certification and understands that the provisions of 31 U.S.C. Sections 3801 et
seq. are applicable hereto.
TA
Executed this ie day of Sune Shae
By: “Zo Ca
(Signature of authorized official)
Cantracting OCicer
(Title of authorized official)
