WMOD00263 ‎(2)‎

• Applicant: CWCB
• Sponsor Name: USBR
• Project Name: Response to RFP
• Title: Numerical Simulations of Snowpack Augmentation for Drought Mitigation Studies in the Colorado Rocky Mountains
• Prepared For: USBR
• Prepared By: Joe Busto, CWCB
• Date: 8/20/2003
• Weather Modification - Doc Type: Application

-

I

U.S. Department of the Interior

I

Certifications Regarding Debarment, Suspension and
Other Responsibility Matters, Drug-Free Workplace
Requirements and Lobbying

I

Persons signing this form should refer to the regulations
referenced below for complete instructions

Certification Regarding Debarment, Suspension, Ineligibility
and Voluntary Exclusion- Lower Tier Covered Transactions -
(See Appendix B of Subpart D of 43 CFR Part 12.)

I

Certification Regarding Debarment, Suspension, and Other
Responsibility Mallers - Primary Covered Transactions - The
prospective primary participant further agrees by submitting
this proposal that it will include the clause tilled,
"Certification Regarding Debarment, Suspension, Ineligibility
and Voluntary Exclusion - Lower Tier Covered Transactions,"
provided by the department or agency entering into this
covered transaction. without modification, in all lower tier
covered transactions. See below for language to be used or
use this form for certification and sign. (See Appendix A of
Subpart D of 43 CFR Part 12.)

Certification Regarding Drug-Free Workplace Requirements -
Alternate I. (Grantees Other Than Individuals) and Alternate
II. (Grantees Who are Individuals) - (See Appendix C of
Subpart D of 43 CFR Part 12)

I

I

Signature on this form provides for compliance with
certification requirements under 43 CFR Parts 12 and 18.
The certifications shall be treated as a material
representation of fact upon which reliance will be placed
when the Department of the Interior determines to award
the covered transaction, grant. cooperative agreement or
loan.

1

PART A:

Certification Regarding Debarment, Suspension. and Other Responsibility Matters -
Primary Covered Transactions

CHECK X/F THIS CERTIFICA TlON IS FOR A PRIMARY COVERED TRANSACTION AND IS APPLICABLE

I

I

(1) The prospective primary participant certifies to the best of its knowledge and belief, that it and its principals:

(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by
and Federal department or agency;

I
I

(b) 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;

I

(c) Are not presently indicted for or othelWise criminally or civilly charged by a governmental entity (Federal. State
or local) with commission of any of the offenses enumerated in paragraph (1 )(b) of this certification; and

(d) 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.

I

(2) Where the prospective primary participant is unable to certify to any of the statements in this certjfication, such
prospective participant shall attach an explanation to this proposal.

I

PART B: Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -
. Lower Tier Covered Transactions

I

CHECK __'F THIS CERTlFICA TION IS FOR A LOWER TIER COVERED TRANSACTION AND IS APPLICABLE.

I

(1) 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
Iransaction 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 Ihis proposal.

I

I

01-2010
JUIIC 1~5
(lhlll tlllm IOlllaCfm OI-19{j3, 01-1054
Dl-1055. DI-1fr56 and 01-19(3)

I