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<br />. . <br />u.s. DEPARTMENT OF AGRIC~LTURE <br /> <br />Certification Regarding Debarment, Suspension, and Other <br />Responsibility Matters - Primary Covered Transactions <br /> <br />This certification is required by the regul~tions implementing Executive Order 12549, <br />Debar.ent and Suspension, 7 CFR Part 3017, Section 3017.510, Participants' responsibilities. <br />The regulations were published as Part IV of the January 30, 1989, Federal Reqister (pages <br />4722.4733). Copies of the regulations ..y be obtained by contacting the ~epartment of <br />Agriculture agency offering the proposed covered transaction. <br /> <br />(BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS ON REVERSE) <br /> <br />(1) The prospective prl..ry participant certifies to the best of Its knowledge and belief, <br /> <br />that It and its principals: <br /> <br />(a) <br /> <br />are not presently debarred, suspended, proposed for debarment, declared <br />Ineligible, or voluntarily eXCluded fr~ covered transa~tions by any Federal <br />depart..nt or agency; <br /> <br />(b) <br /> <br />have not within a three.year period preceding this proposal been convicted of or <br />had a civil Judgment'rendered against the. for c~ission of fraud or a crl.inal <br />offense In connection with obtaining, atte~tfng to obtain, or perfor.lng a public <br />(Federal, State or local) transaction or contrac(under a publfc transaction; <br />vfolatlon of Federal or State antftrust ~tatutes or commission of e.bezzlement, <br />theft, forgery, brfbery, falsfffcation or des~ructlon of records, ..king fal.e <br />stat...nts, or receiving stolen property: <br /> <br />.~ <br /> <br />(c) <br /> <br />are not presently Indicted for o~ ot~erwfse cri.inally or civilly charged by a <br />governm.ntal entity (Federal, State or local) wfth co.-isslon of any of the <br />offenses enu.erated fn paragraph (1)(b) of this certfflcatlon; and <br /> <br />(d) have not wlthfn a three.year period preceding this application/proposal had one or <br />~re publfc transactfons (Federal,,'State or local) ter.inated for cause or <br />defaUlt. <br /> <br />(2) Where the prospective pr,faery partfcfpant fs unable to certify to any of the state.ents <br />fn this certification, such prospective participant shall attach an explanation to this <br />proposal. <br /> <br />County of Hawai'i <br />Organization Na.e <br /> <br />Rural Housin2 Preservation Grant <br />PR/Award Number or Project Na.e <br /> <br />Stephen K. Yamashiro. Mayor <br />,Na.. and Title of Authorized Representative <br /> <br />Signature <br /> <br />Date <br /> <br />For. AO.1047 (2/89) <br /> <br />i <br />. <br /> <br />- <br />