Common use of SUBSCRIBED AND SWORN TO before Clause in Contracts

SUBSCRIBED AND SWORN TO before. me this day of , in the year by who is personally known to me or has produced as identification. NOTARY PUBLIC, signature PRINTED NAME Commission#: (Seal) Commission expires: Exhibit 3 ‐ Debarment Form 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, 34 C.F.R. Part 85, Section 85.510, Participants responsibilities. The regulations were published as Part VII of the May 26, 1988 Federal Register (pages 19160 ‐ 19211). ***** BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS ON NEXT PAGE *****

SUBSCRIBED AND SWORN TO before. me this day of , in the year by who is personally known to me or has produced as identification. NOTARY PUBLIC, signature PRINTED NAME Commission#: (Seal) Commission expires: Exhibit 3 ‐ Debarment Form 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, 34 C.F.R. Part 85, Section 85.510, Participants responsibilities. The regulations were published as Part VII of the May 26, 1988 1988, Federal Register (pages 19160 ‐ 19211). ***** BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS ON NEXT PAGE *****