Common use of CERTIFICATION REGARDING DEBARMENT AND SUSPENSION Clause in Contracts

CERTIFICATION REGARDING DEBARMENT AND SUSPENSION. (applies to Applicants as well as States) 1. By signing and submitting this proposal, the prospective primary participant is providing the certification set out below. 2. The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction. The prospective participant shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department or agency’s determination whether to enter into this transaction. However, failure of the prospective primary participant to furnish a certification or an explanation shall disqualify such person from participation in this transaction. 3. The certification in this clause is a material representation of fact upon which reliance was placed when the department or agency determined to enter into this transaction. If it is later determined that the prospective primary participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause or default. 4. The prospective primary participant shall provide immediate written notice to the department or agency to which this proposal is submitted if at any time the prospective primary participant learns its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 5. The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transaction, principal, proposal, and have the meaning set out in the Definitions and coverage sections of 49 CFR Part 29. You may contact the department or agency to which this proposal is being submitted for assistance in obtaining a copy of those regulations. 6. The prospective primary participant agrees by submitting this proposal 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 proposed for debarment under 48 CFR Part 9, subpart 9.4, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency entering into this transaction. 7. The prospective primary participant further agrees by submitting this proposal that it will include the clause titled “Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion- Lower Tier Covered Transaction”, provided by the department or agency entering into this covered transaction, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. 8. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not proposed for debarment under 48 CFR Part 9, subpart 9.4, 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 list of Parties Excluded from Federal Procurement and Non-procurement Programs. 9. 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. 10. Except for transactions authorized under paragraph 6 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is proposed for debarment under 48 CFR Part 9, subpart 9.4, suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause or default.

CERTIFICATION REGARDING DEBARMENT AND SUSPENSION. Regulations of the Department of Health and Human Services, located at Part 376 of Title 2 of the Code of Federal Regulations (applies CFR), implement Executive Orders 12549 and 12689 concerning debarment and suspension of participants in federal programs and activities. Executive Order 12549 provides that, to Applicants the extent permitted by law, Executive Departments and agencies shall participate in a government-wide system for non-procurement debarment and suspension. Executive Order 12689 extends the debarment and suspension policy to procurement activities of the federal government. A person who is debarred or suspended by a federal agency is excluded from federal financial and non-financial assistance and benefits under federal programs and activities, both directly (primary covered transaction) and indirectly (lower tier covered transactions). Debarment or suspension by one federal agency has government-wide effect. Pursuant to the above-cited regulations, the DEPARTMENT (as well a participant in a primary covered transaction) may not knowingly do business with a person who is debarred, suspended, proposed for debarment, or subject to other government-wide exclusion (including any exclusion from Medicare and State health care program participation on or after August 25, 1995), and the DEPARTMENT must require its prospective CONTRACTORS, as States) 1. prospective lower tier participants, to provide the certification as set forth below: By signing and this Contract or submitting this proposala proposal pursuant to a solicitation issued by the Department, the prospective primary lower tier participant is providing the certification set out below.: 2. The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction. The prospective participant shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department or agency’s determination whether to enter into this transaction. However, failure of the prospective primary participant to furnish a certification or an explanation shall disqualify such person from participation in this transaction. 3. a) The certification in this clause is a material representation of fact upon which reliance was placed when the department or agency determined to enter into this transactiontransaction was entered into. If it is later determined that the prospective primary lower tier participant knowingly rendered an erroneous certification, in addition to the other remedies available to the Federal Government, New York State or the department or agency DEPARTMENT may terminate this transaction for cause or defaultpursue available remedies, including suspension and/or debarment. 4. b) The prospective primary lower tier participant shall provide immediate written notice to the department or agency person to which whom this proposal is submitted if at any time the prospective primary lower tier participant learns that its certification was erroneous when submitted or has had become erroneous by reason of changed circumstances. 5. c) The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transactionTransaction, principal, proposal, and have the meaning set out voluntarily excluded, as used in the Definitions and coverage sections of 49 this Section, are defined in 2 CFR Part 29. You may contact the department or agency to which this proposal is being submitted for assistance in obtaining a copy of those regulations180, as supplemented by 2 CFR Part 376. 6. d) The prospective primary lower tier participant agrees by signing this contract or submitting this a proposal pursuant to a solicitation issued by the DEPARTMENT 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 proposed for debarment under 2 CFR Part 180, as supplemented by 2 CFR Part 376, or 48 CFR Part 9, subpart Subpart 9.4, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency entering into this transactionDEPARTMENT. 7. e) The prospective primary lower tier participant further agrees by submitting signing this contract or proposal that it will include the this clause titled “Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion- Exclusion-Lower Tier Covered Transaction”, provided by the department or agency entering into this covered transaction, ,” without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. 8. f) A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not proposed for debarment under 2 CFR Part 180, as supplemented by 2 CFR Part 376, or 48 CFR Part 9, subpart Subpart 9.4, debarred, suspended, ineligible, or voluntarily excluded from the covered transactiontransactions, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its it principals. Each The DEPARTMENT strongly encourages each participant may, but is not required to, to check the list List of Parties parties Excluded from Federal Procurement and Non-procurement ProgramsPrograms in the System for Award Management. 9. g) 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 dealingsSection. 10. h) Except for transactions authorized under paragraph 6 (d) of these instructionsthis certification, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is proposed for debarment under 2 CFR Part 180 or 48 CFR Part 9, subpart Subpart 9.4, suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department New York State or agency the DEPARTMENT may terminate pursue available remedies, including suspension and/or debarment. i) Certification regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion – Lower Tier Covered Transactions j) The prospective lower tier participant certifies, by signing this contract or submitting a proposal to the Department, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily exclude from participation in this transaction for cause or defaultby any federal agency. k) 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.

CERTIFICATION REGARDING DEBARMENT AND SUSPENSION. Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion. Federal money will be used or may potentially be used to pay for all or part of the work under the contract, therefore the prospective lower tier participants (applies to Applicants County Attorney and County Sheriff) must certify the following, as well as States)required by the regulations implementing Executive Order 12549: A. Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion – Lower Tier Covered Transactions. 1. By signing and submitting this proposalCooperative Arrangement, the prospective primary lower tier participant is providing the certification set out below. 2. The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction. The prospective participant shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department or agency’s determination whether to enter into this transaction. However, failure of the prospective primary participant to furnish a certification or an explanation shall disqualify such person from participation in this transaction. 3. The certification in this clause is a material representation of fact upon which reliance was placed when the department or agency determined to enter into this transactiontransaction was entered into. If it is later determined that the prospective primary lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency may terminate with which this transaction for cause or defaultoriginated may pursue available remedies, including suspension and/or debarment. 43. The prospective primary lower tier participant shall provide immediate written notice to the department or agency person to which this proposal is submitted if at any time the prospective primary lower tier participant learns that its certification was erroneous when submitted or has had become erroneous by reason of changed circumstances. 54. 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 meaning set out in the Definitions and coverage Coverages sections of 49 CFR Part 29. You rules implementing Executive Order 12549 (Debarment and Suspension).You may contact the department or agency person to which this proposal Cooperative Arrangement is being submitted for assistance in obtaining a copy of those regulations. 65. The prospective primary lower tier participant agrees by submitting this proposal response 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 proposed for debarment under 48 CFR Part C.F.R., part 9, subpart 9.4, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency entering into with which this transactiontransaction originated. 76. The prospective primary lower tier participant further agrees by submitting this proposal that it will include the this clause titled “Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion- Exclusion--Lower Tier Covered Transaction”, provided by the department or agency entering into this covered transaction, ,” without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. 87. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not proposed for debarment under title 48 CFR Part of the C.F.R., part 9, subpart 9.4, debarred, suspended, ineligible, or voluntarily excluded from the covered transactiontransactions, 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 list List of Parties Excluded from Federal Procurement and Non-procurement Nonprocurement Programs. 98. 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. 109. Except for transactions authorized under paragraph 6 five of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is proposed for debarment under Title 48 CFR Part of the C.F.R., part 9, subpart 9.4, suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Governmentfederal government, the department or agency may terminate with which this transaction for cause or defaultoriginated may pursue available remedies, including suspension and/or debarment.

CERTIFICATION REGARDING DEBARMENT AND SUSPENSION. (applies to Applicants as well as States) 1. By signing and submitting this proposal, the prospective primary participant is providing the certification set out below. 21. The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction. The prospective participant shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department Department or agency’s 's determination whether to enter into this transaction. However, failure of the prospective primary participant to furnish a certification or an explanation shall disqualify such person from participation in this transaction. 32. The certification in this clause is a material representation of fact upon which reliance was placed when the department Department or agency determined to enter into this transaction. If it is later determined that the prospective primary participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department Department or agency may terminate this transaction for cause or default. 43. The prospective primary participant shall provide immediate written notice to the department Department or agency to which this proposal is submitted if at any time the prospective primary participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 54. 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 meaning meanings set out in the Definitions and coverage Coverage sections of 49 CFR Part 29the rules implementing Executive Order 12549. You may contact the department Department or agency to which this proposal is being submitted for assistance in obtaining a copy of those regulations. 65. The prospective primary participant agrees by submitting this proposal 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 proposed for debarment under 48 CFR Part part 9, subpart 9.4, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department Department or agency entering into this transaction. 7. The prospective primary participant further agrees by submitting this proposal that it will include the clause titled “Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion- Lower Tier Covered Transaction”, provided by the department or agency entering into this covered transaction, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. 8. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not proposed for debarment under 48 CFR Part 9, subpart 9.4, 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 list of Parties Excluded from Federal Procurement and Non-procurement Programs. 9. 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. 10. Except for transactions authorized under paragraph 6 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is proposed for debarment under 48 CFR Part 9, subpart 9.4, suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause or default.

CERTIFICATION REGARDING DEBARMENT AND SUSPENSION. (applies to Applicants as well as States) 1. By signing and submitting this proposal, the prospective primary participant is providing the certification set out below. 21. The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction. The prospective participant shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department Department or agency’s 's determination whether to enter into this transaction. However, failure of the prospective primary participant to furnish a certification or an explanation shall disqualify such person from participation in this transaction. 32. The certification in this clause is a material representation of fact upon which reliance was placed when the department Department or agency determined to enter into this transaction. If it is later determined that the prospective primary participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department Department or agency may terminate this transaction for cause or default. 43. The prospective primary participant shall provide immediate written notice to the department Department or agency to which this proposal is submitted if at any time the prospective primary participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 54. 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 meaning meanings set out in the Definitions and coverage Coverage sections of 49 CFR Part 29the rules implementing Executive Order 12549. You may contact the department Department or agency to which this proposal is being submitted for assistance in obtaining a copy of those regulations. 65. The prospective primary participant agrees by submitting this proposal 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 proposed for debarment under 48 CFR Part part 9, subpart 9.4, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department Department or agency entering into this transaction. 76. The prospective primary participant further agrees by submitting this proposal that it will include the clause titled “Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion- Exclusion-Lower Tier Covered Transaction”, ,” provided by the department Department or agency entering into this covered transaction, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. 87. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not proposed for debarment under 48 CFR Part part 9, subpart 9.4, 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 list List of Parties Excluded from Federal Procurement and Non-procurement Programs. 98. 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. 109. Except for transactions authorized under paragraph 6 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is proposed for debarment under 48 CFR Part part 9, subpart 9.4, suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department Department or agency may terminate this transaction for cause or default. The undersigned (authorized official signing for the applicant organization) certifies to the best of his or her knowledge and belief that the applicant defined as the primary participant in accordance with 48 CFR Part 9, subpart 9.4 and its principles: 1. The prospective primary participant certifies to the best of its knowledge and belief that it and its principals: 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 a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offence in connection with obtaining, attempting to obtain or performing a public (Federal, State or local) transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statement or receiving stolen property; c) are not presently indicated 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 d) have not within a three-year period preceding this application/proposal had one or more public transaction (Federal, State or local) terminated for cause or default. 2. Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this Contract (Signature of Official Authorized to Sign Application) (Date) (Print Name) (Title) (Agency / Contractor Name) (Title of Program) DEPARTMENT OF HEALTH SERVICES STATE OF WISCONSIN Division of Enterprise Services F-00714 (05/2014) BUSINESS ASSOCIATE AGREEMENT 2016 State and _ _ County Contract This Business Associate Agreement is made between the Wisconsin Department of Health Services, __ (“Covered Entity”), and the _ (“Business Associate”), collectively the “Parties.” This Agreement is specific to those services, activities, or functions performed by the Business Associate on behalf of the Covered Entity when such services, activities, or functions are covered by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), including all pertinent regulations (45 CFR Parts 160 and 164) issued by the U.S. Department of Health and Human Services. Services, activities, or functions covered by this Agreement include, but are not limited to, Social Services, Community Program, and functions performed and services provided or purchased by the _ _ _ _ as specified in the 1B2016 State and _ _ County Contract.