AD-1048 Certification Regarding Disbarment, Suspension, Ineligib

U.S. DEPARTMENT OF AGRICULTURE

Certification Regarding Debarment, Suspension, Ineligibility
and Voluntary Exclusion - Lower Tier Covered Transactions
This certification is required by the regulations implementing Executive Order 12549, Debarment and Suspension, 7 CFR
Part 3017, Section 3017.510, Participants' responsibilities. The regulations were published as Part IV of the January 30,
1989, Federal Register (pages 4722-4733). Copies of the regulations may be obtained by contacting the Department of
Agriculture agency with which this transaction originated.
(BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS ON REVERSE)
(1)

The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is
presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
participation in this transaction by any Federal department or agency.

(2)

Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such
prospective participant shall attach an explanation to this proposal.

Organization Name

PR/Award Number or Project Name

Name and Title of Authorized Representative
Signature

Date

(mm/dd/yyyy)

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Form AD-1048 (2/89)
This form was electronically produced using Applix 4.41

INSTRUCTIONS FOR CERTIFICATION
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By signing and submitting this form, the prospective lower tier participant is providing the certification set out on
the reverse side in accordance with these instructions.
The certification in this clause is a material representation of fact upon which reliance was placed when this
transaction was entered into. If it is later determined that the prospective lower tier participant knowingly
rendered an erroneous certification, in addition to other remedies available to the Federal Government, the
department or agency with which this transaction originated may pursue available remedies, including
suspension and/or debarment.
The prospective lower tier participant shall provide immediate written notice to the person to which this proposal
is submitted if at any time the prospective lower tier participant learns that its certification was erroneous when
submitted or has become erroneous by reason of changed circumstances.
The terms ``covered transaction,'' ``debarred,'' ``suspended,'' ``ineligible,'' ``lower tier covered transaction,''
``participant,'' ``person,'' ``primary covered transaction,'' ``principal,'' ``proposal,'' and ``voluntarily excluded,'' as
used in this clause, have the meanings set out in the Definitions and Coverage sections of rules implementing
Executive Order 12549. You may contact the person to which this proposal is submitted for assistance in
obtaining a copy of those regulations.
The prospective lower tier participant agrees by submitting this form that, should the proposed covered
transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who
is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction,
unless authorized by the department or agency with which this transaction originated.
The prospective lower tier participant further agrees by submitting this form that it will include this clause titled
``Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered
Transactions,'' without modification, in all lower tier covered transactions and in all solicitations for lower tier
covered transactions.
A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier
covered transaction that is not debarred, suspended, ineligible, or voluntarily excluded from the covered
transaction, unless it knows that the certification is erroneous. A participant may decide the method and
frequency by which it determines the eligibility of its principals. Each participant may, but is not required to,
check the Nonprocurement List.
Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to
render in good faith the certification required by this clause. The knowledge and information of a participant is
not required to exceed that which is normally possessed by a prudent person in the ordinary course of business
dealings.
Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered
transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred,
ineligible, or voluntarily excluded from participating in this transaction, in addition to other remedies available to
the Federal Government, the department or agency with which this transaction originated may pursue available
remedies, including suspension and/or debarment.

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Form AD-1048 (2/89)
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