Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion (Appendix D)
  • Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion (Appendix D)

  • (2 CFR 200.214; 2 CFR Part 180)
  • A. Purpose

  • Federal regulations require non-federal entities to ensure that all contractors, subcontractors, and vendors receiving federal funds are not suspended, debarred, or otherwise excluded from participation in federal programs. This certification must be completed by all entities seeking to contract under a federally funded award.
  • B. Certification

  • 1. It and its principals are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in transactions covered by 2 CFR Part 180 or 2 CFR 200.214 by any federal department or agency.
  • 2. It and its principals have not, within the three-year period preceding this certification, been convicted of or had a civil judgment rendered against them for fraud, antitrust violations, embezzlement, theft, bribery, falsification of records, making false statements, or receiving stolen property.
  • 3. It and its principals are not presently indicted or otherwise criminally or civilly charged by a governmental entity with any of the offenses listed above.
  • 4. It and its principals have not, within the past three years, had a public transaction terminated for cause or default.
  • 5. The contractor agrees to immediately notify the contracting agency if it or any of its principals become subject to a debarment or suspension action during the term of the contract.
  • C. Verification Requirement

  • The contractor acknowledges that the contracting agency may verify this information by checking the System for Award Management (SAM.gov) exclusion database.
  • D. Certification Statement

  • Format: (000) 000-0000.
  • Clear
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  • Should be Empty: