New Jersey Department of Human Services Division of Family Development Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions 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 transaction by an Federal or State department or agency. 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 this proposal. Name and Title of Agency Official __________________________________ Signature _________________________ Date _____________________________ This certification is required by the regulations implementing Executive order 12549, Debarment and Suspension, 29 CFR Part 98, Section 98.510 STATE OF NEW JERSEY DIVISION OF FAMILY DEVELOPMENT STANDARDIZED BOARD RESOLUTION FORM page 1 of 2 –
New Jersey Department of Human Services Division of Family Development Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions 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 transaction by an Federal or State department or agency. 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 this proposal. Name and Title of Agency Official __________________________________ Signature _________________________ Date _____________________________ This certification is required by the regulations implementing Executive order 12549, Debarment and Suspension, 29 CFR Part 98, Section 98.510 STATE OF NEW JERSEY DIVISION OF FAMILY DEVELOPMENT STANDARDIZED BOARD RESOLUTION FORM – page 1 of 2