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U.S. DEPARTMENT OF J�UST'ICEO <br />OFFICE OF'J�U�STICE PROGRAMS <br />OFFICE OF THE COMPTROLLER <br />Certification Regarding <br />Debarment, Suspensioni Ineligibility and Vol�un�tary Exclusion <br />41 <br />Lower Tier Colveried Transactions <br />(Sub-Rieci lient) <br />P <br />Af This certification is required by the reglulatiolns Implementing Executive Order 12549, Debarment and <br />Suspensioin, 28, CF'R Part 67, Section 67.510; Participants" responsibilities. The regulations were publ"ts*hed <br />as Pa,rt V11 of the May 26,9 198,81 Federal' Register (pagies 19160-19211)* <br />('BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS ON REVERSE) <br />The prospective lower tier partlicipant, cirtifies, by submission, of, this proposal, that "nether it nor its <br />prinicipals are presently debarred�, suspeln�ded,,proposed' for debarm en�ti declared ineligible, or voluntarily <br />ex,cl,uded from participation in this transaction by any Federal department or agency. <br />41 <br />(2) Where the prospective lower tier participant is unable to certify to any of the statements in this cerfifi- <br />cation, such prospectllve participant shall attaich an explanation to this proposal. <br />City of -'Roseviille on beha,l,f of the Mayors,' Ccxmission Aaainst Drugs of Roseville, <br />1�au�&lei and Little Canada <br />IP 0 <br />2660 Civiz Center Drive <br />Address of Organization <br />Rose%a* lle , M 551131 <br />OJP FOR�M 406111 (REV. 2189) IPlreviolus editions are obsolete. <br />