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US Environmental Protection Agency OMB Control No. 2040-0292 <br /> WIFIA Program EPA Form No. 6100-032 <br /> Application Approval expires XX/XX/XXXX <br /> ____________________________________________________________________________________ <br />53 <br />3. The undersigned shall require that the language of this certification be included in the <br />award documents for all subawards at all tiers (including subcontracts, subgrants, and <br />contracts under grants, loans, and cooperative agreements) and that all subrecipients shall <br />certify and disclose accordingly. <br />This certification is a material representation of fact upon which reliance was placed when <br />this transaction was made or entered into. Submission of this certification is a prerequisite <br />for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any <br />person who fails to file the required certification shall be subject to a civil penalty of not less <br />than $10,000 and not more than $100,000 for each such failure. <br />7. Debarment: The undersigned further certifies that it is not currently: 1) debarred or <br />suspended from participating in any Federal programs; 2) formally proposed for debarment, <br />with a final determination still pending; or 3) indicted, convicted, or had a civil judgment <br />rendered against it for any of the offenses listed in the Regulations Governing Debarment and <br />Suspension (Governmentwide Nonprocurement Debarment and Suspension Regulations: 2 <br />C.F.R. Part 180 and Part 1532). <br />8. Default/Delinquency: The undersigned further certifies that neither it nor any of its subsidiaries <br />or affiliates are currently in default or delinquent on any debt or loans provided or guaranteed <br />by the Federal Government. <br />9. Other Federal Requirements: The applicant acknowledges that it must comply with all other <br />federal statutes and regulations, as applicable. A non-exhaustive list of federal cross-cutting <br />statutes and regulations can be found at: https://www.epa.gov/wifia/wifia- <br />resources#complianceanchor. <br /> <br />10. Signature: By submitting this application, the undersigned certifies that the facts stated and the <br />certifications and representations made in this application are true, to the best of the <br />applicant’s knowledge and belief after due inquiry, and that the applicant has not omitted any <br />material facts. The undersigned is an authorized representative of the applicant. <br />Signature: _________________________________________________________________________ <br />Date Signed: ________________________________________________________________________ <br /> <br />Name: <br />Title: <br />Organization: <br />Street Address: <br />City/State/Zip: <br />Phone: <br />E-mail: <br />