The interested party hereby certifies to the best of its knowledge and belief that it and its principals:
- is not presently declared ineligible, or excluded from receiving federal assistance from any federal agency;
- does not currently owe a debt to the federal government for outstanding taxes;
- has not, within a three-year period preceding this form's submission, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining or attempting to obtain public funds;
- is not presently indicted for or otherwise criminally or civilly charged by a government entity with commission of any of the offenses noted above.
By virtue of checking the box below and submitting this form online I, the potential panelist, certify that all information contained herein is true.