1999-02-19_GENERAL DOCUMENTS - C1981017 (2)

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'U.S. DEPARTMENT OF THE INTERIOR Office of Surface Mining Reclamation and Enforcement Certifications Regarding Debarment, Suspension and Other Responsibility Matters, Drug-Free Workplace Requirements and Lobbying Persons signing this form should refer to the Certification Regarding Drug-Free Workplace regulations referenced below for complete instructions. Requirements (Grantees Other Than Individuals) (See Appendix C of Subpart D of 43 CFR 12). Certification Regarding Debarment, Suspension and Other Responsibility Matters - Primary Covered Certification Regarding Lobbying (See 43 CFR 18). Transactions. (See Appendix A of Subpart D of 43 CFR 12). Signature on this form provides for compliance with certification requirements under 43 CFR Pans 12 and Certification Regarding Debarment, Suspension, 18. The certifications shall be treated as a material Ineligibility and Voluntary Exclusion - Lower Tier representation of fact upon which reliance will be Covered Transactions (See Appendix B of Subpart D placed when the Office of Surface Mining determines of 43 CFR 12). to award the covered transaction, grant or cooperative agreement. PART A: Certification Regarding Debarment, Suspension and Other Responsibility Matters- Primary Covered Transactions X CHECK IF THIS CERTIFICAT70N IS FOR A PRIMARY COVERED TRANSACTION AND IS APPLICABLE 1. The propsective primary participant certifies to the best of its knowledge and belief, that it and its principles: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency. (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 of destruction of records, making false statements, or receiving stolen property. (c) Are not presently indicted for or otherwise criminally or civilly charged by a government entity (Federal, State or local) 2. The prospective primary participant agrees by submitting this proposal that it will include the clauses under Pan B: Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion- Lower Tier Covered Transaction, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. 3. Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. 11