REVISEDCERTIFICATION-OF-NON-DEBARMENT.PDF

CERTIFICATION OF NON-DEBARMENT OR SUSPENSION 
In accordance with Executive Order 12549 and Executive Order 12689, entitled Debarment and 
Suspension, and any applicable implementing regulations, this certification must be completed by 
the Organization:  
1. Under penalty of perjury, except as noted below, all persons or firms or any person associated
therewith in the capacity of owner, partner, director, officer, or manager:
a.
Are not presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from covered transactions by any federal department or agency.
b.
Have not, within the three (3) year period preceding this certification, been convicted
of or had a civil judgment rendered against them for commission of fraud or a criminal
offense in connection with obtaining, attempting to obtain, or performing a public
(federal, state, or local) transaction or contract under a public transaction, violation of
Federal or state antitrust statutes, or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false statements, or receiving
stolen property;
c.
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
listed in subparagraph (1)(b) of this certification; and
d.
Have not, within the three (3) year period preceding this certification, had one or more
public transactions (Federal, state, or local) terminated for cause or default.
e.
Will not subcontract with parties listed on the General Services Administration’s List
of Parties Excluded from Federal Procurement or Non-procurement Programs
2. If such persons or firms later become aware of any information contradicting the statements of
paragraph (1), they will promptly provide that information to NACCHO.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL 
TITLE 
ORGANIZATION 
DATE SIGNED 
ATTEST
__________________________________
Clerk of the Board
__________________________________
Date
APPROVED AS TO FORM
__________________________________
Attorney for Maricopa County 
__________________________________
Date
Chairman, Board of Supervisors
For and on behalf of Maricopa County: