289-24 Agreement Blank to Sponsor-West Orange.pdf

March 2022 New Jersey Department of Transportation Division of Local Aid and Economic Development Federal Aid Cost Reimbursement Agreement 29 APPENDIX E CERTIFICATION OF SUBRECIPIENT ELIGIBILITY I _____________________________________ hereby certify under penalty of perjury under the laws of the United States, that except as noted below, the company or any person associated therewith in the capacity of owner, partner, director, officer, principal, Project director, manager, auditor, or any position involving the administration of State funds: is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by any federal, State or local government agency; has not been suspended, debarred, voluntarily excluded or determined ineligible by any federal, State or local government agency within the past 3 years; does not have a proposed debarment pending; and has not been indicted, convicted, or had a civil judgment rendered against (it) by a court of competent jurisdiction in any matter involving fraud or official misconduct within the past 3 years. (Insert exceptions - for any exception noted, indicate to whom it applies, initiating agency, and dates of action. Providing false information may result in criminal prosecution or administrative sanctions. If no exceptions, insert "None".) Attest: SUBRECIPIENT ____________________________________ ____________________________________ Name/Title Name/Title Date: __________________