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<br />GRANTEE <br />Cass County <br /> <br />By: <br /> <br />Title: <br /> <br />Robyn Sorum <br />Commission Chair <br /> <br />Date: <br /> <br />NORTH DAKOTA <br />ASSOCIATION OF COUNTIES <br /> <br />By: <br /> <br />Title: <br /> <br />Date: <br /> <br />STATE OF NORTH DAKOTA, BY <br />AND THROUGH ITS <br />DEPARTMENT OF <br />CORRECTIONS AND <br />REHABILITATION AND THE <br />DIVISION OF JUVENILE <br />SERVICES <br /> <br />By: <br /> <br />Title: <br /> <br />Date: <br /> <br />CERTIFICATION REGARDING DEBARMENT. SUSPENSION. INELIGIBILITY. AND <br />VOLUNTARY EXCLUSION FOR LOWER TIER COVERED TRANSACTIONS <br /> <br />This certification is required by the regulations implementing Executive Order 12549, <br />Debannent and Suspension, 28 C.F,R. Part 67, Section 67.510 , Participants' responsibilities. <br />The regulations were published as Part vn of the May 26, 1988, Federal Register (pages 19160- <br />19211). <br /> <br />1, The prospective lower tier participant certifies, by submission of this proposal, that <br />neither it nor its principals are presently debarred, suspended, proposed for <br />debannent, declared ineligible, or voluntarily excluded from participation in this <br />transaction by any federal department or agency. <br />2. Where the lower tier participant is unable to certify to any of the statements in this <br />certification, such prospective participant shall attach an explanation to this proposal. <br /> <br />Cass County <br />Name of Grantee <br /> <br />Signature of Authorized Official <br /> <br />Date <br /> <br />Robyn Sorum, Commission Chair <br />Printed Name and Title of Authorized Official <br /> <br />4 <br />