Common use of DEBARMENT, PERFORMANCE, AND NON-COLLUSION CERTIFICATION Clause in Contracts

DEBARMENT, PERFORMANCE, AND NON-COLLUSION CERTIFICATION. By signing this Contract, the Provider certifies to the best of Provider’s knowledge and belief that the aforementioned organization, its principals and any subcontractors named in this Contract: a. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from bidding or working on contracts issued by any governmental agency. b. Have not within three years of submitting the proposal for this contract been convicted of or had a civil judgment rendered against them for: i. Fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a federal, state or local government transaction or contract. ii. Violating Federal or State antitrust statutes or committing embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; iii. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or Local) with commission of any of the offenses enumerated in paragraph (b) of this certification; and iv. Have not within a three (3) year period preceding this proposal had one or more federal, state or local government transactions terminated for cause or default. c. Have not entered into a prior understanding, agreement, or connection with any corporation, firm, or person submitting a response for the same materials, supplies, equipment, or services and this proposal is in all respects fair and without collusion or fraud. The above-mentioned entities understand and agree that collusive bidding is a violation of state and federal law and can result in fines, prison sentences, and civil damage awards. Enter the exceptions here if applicable. If not applicable, enter NA and make sure Rider C is not checked in the Rider section Enter Rider D here if applicable. If not applicable either delete this page and remove from the Rider section or enter NA– make sure Rider D is not checked. Enter Rider E here if applicable. If not applicable either delete this page and remove from the Rider section or enter NA– make sure Rider E is not checked. Enter Rider F here if applicable. If not applicable either delete this page and remove from the Rider section or enter NA– make sure Rider F is not checked. Please identify the country in which the services purchased through this contract will be performed: Notification of Changes to the Information The Provider agrees to notify the Division of Procurement Services of any changes to the information provided above. Enter BAA here if applicable. If not applicable either delete this page and remove from the Rider section or enter NA– make sure Business Associate Agreement is not checked.

DEBARMENT, PERFORMANCE, AND NON-COLLUSION CERTIFICATION. By signing this Contract, the Provider certifies to the best of Provider’s knowledge and belief that the aforementioned organization, its principals and any subcontractors named in this Contract: a. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from bidding or working on contracts issued by any governmental agency. b. Have not within three years of submitting the proposal for this contract been convicted of or had a civil judgment rendered against them for: i. Fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a federal, state or local government transaction or contract. ii. Violating Federal or State antitrust statutes or committing embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; iii. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or Local) with commission of any of the offenses enumerated in paragraph (b) of this certification; and iv. Have not within a three (3) year period preceding this proposal had one or more federal, state or local government transactions terminated for cause or default. c. Have not entered into a prior understanding, agreement, or connection with any corporation, firm, or person submitting a response for the same materials, supplies, equipment, or services and this proposal is in all respects fair and without collusion or fraud. The above-mentioned entities understand and agree that collusive bidding is a violation of state and federal law and can result in fines, prison sentences, and civil damage awards. Enter the exceptions here if applicable. If not applicable, enter NA and make sure Rider C is not checked in the Rider section Enter Rider D here if applicable. If not applicable either delete this page and remove from the Rider section or enter NA– make sure Rider D is not checked. Enter Rider E here if applicable. If not applicable either delete this page and remove from the Rider section or enter NA– make sure Rider E is not checked. Enter Rider F here if applicable. If not applicable either delete this page and remove from the Rider section or enter NA– make sure Rider F is not checked. Please identify the country in which the services purchased through this contract will be performed: Notification of Changes to the Information The Provider agrees to notify the Division of Procurement Services of any changes to the information provided above. Enter BAA here if applicable. If not applicable either delete this page and remove from the Rider section or enter NA– make sure Business Associate Agreement is not checked.

DEBARMENT, PERFORMANCE, AND NON-COLLUSION CERTIFICATION. By signing this Contract, the Provider certifies to the best of Provider’s knowledge and belief that the aforementioned organization, its principals and any subcontractors named in this Contract:: Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from bidding or working on contracts issued by any governmental agency. Have not within three years of submitting the proposal for this contract been convicted of or had a civil judgment rendered against them for: Fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a federal, state or local government transaction or contract. Violating Federal or State antitrust statutes or committing embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or Local) with commission of any of the offenses enumerated in paragraph (b) of this certification; and Have not within a three (3) year period preceding this proposal had one or more federal, state or local government transactions terminated for cause or default. Have not Entered into a prior understanding, agreement, or connection with any corporation, firm, or person submitting a response for the same materials, supplies, equipment, or services and this proposal is in all respects fair and without collusion or fraud. The above-mentioned entities understand and agree that collusive bidding is a violation of state and federal law and can result in fines, prison sentences, and civil damage awards. NA Pre-Qualified Vendor List for American Sign Language Interpreter and Video Remote Interpreting Services a. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from bidding or working on contracts issued by any governmental agency. b. Have not within three years of submitting the proposal for this contract been convicted of or had a civil judgment rendered against them for: i. Fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a federal, state or local government transaction or contract. ii. Violating Federal or State antitrust statutes or committing embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; iii. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or Local) with commission of any of the offenses enumerated in paragraph (b) of this certification; and iv. Have not within a three (3) year period preceding this proposal had one or more federal, state or local government transactions terminated for cause or default. c. Have not entered into a prior understanding, agreement, or connection with any corporation, firm, or person submitting a response for the same materials, supplies, equipment, or services and this proposal is in all respects fair and without collusion or fraud. The above-above- mentioned entities understand and agree that collusive bidding is a violation of state and federal law and can result in fines, prison sentences, and civil damage awards. Enter the exceptions here if applicable. If not applicable, enter NA and make sure Rider C is not checked in the Rider section Enter Rider D here if applicable. If not applicable either delete this page and remove from the Rider section or enter NA– make sure Rider D is not checked. Enter Rider E here if applicable. If not applicable either delete this page and remove from the Rider section or enter NA– make sure Rider E is not checked. Enter Rider F here if applicable. If not applicable either delete this page and remove from the Rider section or enter NA– make sure Rider F is not checked. Please identify the country in which the services purchased through this contract will be performed: Notification of Changes to the Information The Provider agrees to notify the Division of Procurement Services of any changes to the information provided above. Enter BAA here if applicable. If not applicable either delete this page and remove from the Rider section or enter NA– make sure Business Associate Agreement is not checked.