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EMERGENCY MEDICAL SERVICES. FIRSI RESPOVDER ADVANCED LII I SUPPORI AGREEMENT (11/1/2011) <br /> EXHIBIT D - DEBARMENT AND SUSPENSION CERTIFICATION <br /> 1. , under penalty of perjury, certifies that, except as noted below, the company, its <br /> principal, and any named subcontractor: <br /> 1.1 Is not currently under suspension, debarment, voluntary exclusion, or determination <br /> of ineligibility by any Federal agency; <br /> 1.2 Has not been suspended, debarred, voluntarily excluded or determined ineligible by <br /> any Federal agency within the past three years; <br /> 1.3 Does not have a proposed debarment pending; and, <br /> 1.4 Has not been indicted, convicted, or had a civil judgment rendered against it by a <br /> court of competent jurisdiction in any matter involving fraud or official misconduct <br /> within the past three years. <br /> 2. If there are any exceptions to this certification, insert the exceptions in the following space. <br /> 3. Exceptions shall not necessary result in denial of award, but shall be considered in <br /> determining Proposer responsibility. For any exception noted above, indicate below to <br /> whom it applies, initiating agency, and dates of action. <br /> 4. Providing false information may result in criminal prosecution or administrative sanctions. <br /> The above certification is part of the Agreement. Signing the Agreement on the signature <br /> portion thereof shall also constitute signature of this Certification. <br /> Name: <br /> Signature: <br /> Title: <br /> Date: / / <br /> Page E-6 <br />