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Form DAC 26-904 (08-91)

As part of a quotation or proposal to MDC expected to exceed $25,000, the Offeror hereby certifies that, to the best of its knowledge and belief, the Offeror or any of its principals are not presently debarred, suspended, proposed for debarment or otherwise declared ineligible for the award of contracts by any Federal agency by the inclusion of the Offeror or its principals in the current "LIST OF PARTIES EXCLUDED FROM FEDERAL PROCUREMENT OR NONPROCUREMENT PROGRAMS" published monthly by the U.S. General Services Administration Office of Acquisition Policy.

"Principals," for the purpose of this certificate, means officers, directors, owners, partners, and persons having primary management or supervisory responsibilities within a business entity.

The Offeror shall provide immediate written notice to MDC if, at any time prior to contract award, it learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.

Failure to provide this certificate will not necessarily result in the with holding of a contract; however, the certificate will be considered in connection with a determination of the Offeror's responsiveness. Failure of the Offeror to furnish such additional information as requested in the absence of this certification may render the Offeror nonresponsive.

Execution of this certification is a material representation of fact upon which reliance may be placed in making a contract award. If it is subsequently determined that this certificate was erroneous, MDC may, in addition to other available remedies, terminate for default any contract resulting from this solicitation.




(Signature of Authorized Representative)


(Print or Type)



DATE __________________________ 

QUOTE# ________________________




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