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<br />u.s. DEPARTMENT OF mSTICE <br />OFFICE OF JUSTICE PROGRAMS <br />OFFICE OF THE COMPTROLLER <br /> <br />CERTIFICATION REGARDING <br /> <br />DEBARMENT, SUSPENSION, INELIGIBILITY <br />AND VOLUNTARY EXCLUSION <br /> <br />LOWER TIER COVERED TRANSACTIONS <br /> <br />(SUB-RECIPIENT) <br /> <br />This certification is required by the regulations implementing Executive Order 12549, Debarment and <br />Suspension, 28 CFR Part 67, Section 67.510, Participant's responsibilities. The regulations were published as <br />Part VII ofthe May 26, 1988 Federal Register (pages 19160-19211). <br /> <br />(1) The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its <br />principals are presently debarred, suspended, proposed for debarment, declared ineligible, or <br />voluntarily excluded from participation in this transaction by any Federal department or agency. <br /> <br />(2) Where the prospective lower tier participation 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 />Birch P. Burdick, Cass County State's Attorney <br /> <br /> <br />Date <br /> <br />Cass County VictimlWitness Program <br /> <br />Name of Organization <br /> <br />PO Box 5806, Fargo, ND 58108 <br /> <br />Address of Organization <br /> <br />12 <br />