Form Ccertification

FORM CCERTIFICATION

Proposer:

Nameof FirmCompletingthisForm:

1.Hasthefirmoranyaffiliate,*oranycurrentofficer,directororemployeeofeitherthefirmoranyaffiliate,beenindictedorconvictedofbid(i.e.,fraud,bribery,collusion,conspiracy,antitrust,etc.)orothercontractrelatedcrimesorviolationsoranyotherfelonyorseriousmisdemeanorwithinthepasttenyears(measuredfromthe dateofissuanceofthisRFQ)?

YesNo

If yes,pleaseexplain:

2.Hasthefirmoranyaffiliate*eversoughtprotectionunderanyprovisionofanybankruptcyactwithinthepasttenyears(measuredfromthedateofissuanceofthisRFQ)?

YesNo

If yes,pleaseexplain:

3.Hasthefirmoranyaffiliate*everbeendisqualified,removed,debarredorsuspendedfromperformingworkforthefederalgovernment,anystateorlocalgovernment,oranyforeigngovernmentalentitywithinthepasttenyears(measured from the dateofissuance ofthisRFQ)?

YesNo

If yes,pleaseexplain:

4.Hasthefirmoranyaffiliate*everbeenfoundliableinacivilsuitorfoundguiltyinacriminalaction for making anyfalseclaimor other materialmisrepresentationtoapublicentitywithinthepasttenyears(measuredfromthedateofissuanceofthisRFQ)?

YesNo

Ifyes,astoeachsuchinquiry,statethenameofthepublicagency,thedateoftheinquiry,thegroundsonwhichthepublicagencybasedtheinquiry,andtheresultof the inquiry.

5.Hasanyconstructionprojectperformedormanagedbythefirmor,totheknowledgeoftheundersigned,anyaffiliate*involvedserious,repeatedormultiplefailurestocomplywithsafetyrules,regulations,orrequirementswithinthepastten years(measured from thedate ofissuanceofthisRFQ)?

YesNo

Ifyes,pleaseidentifytheteam membersand theprojects,provideanexplanationofthecircumstances,andprovideownercontactinformationincludingtelephonenumbersand e-mailaddresses.

6.Hasthefirmoranyaffiliate*beenfound,adjudicatedordeterminedbyanyfederalorstatecourtoragency(including,butnotlimitedto,theEqualEmploymentOpportunityCommission,theOfficeofFederalContractComplianceProgramsandanyapplicableIndianagovernmentalagency)tohaveviolatedanylawsorExecutiveOrdersrelatingtoemploymentdiscriminationoraffirmativeactionwithinthepasttenyears(measuredfromthedateofissuanceofthisRFQ),includingbutnotlimitedtoTitleVIIoftheCivilRightsActof1964,asamended(42U.S.C.Sections2000etseq.);theEqualPayAct(29U.S.C.Section 206(d));andanyapplicable or similarIndianalaw?

YesNo

If yes,pleaseexplain:

7.Hasthefirmoranyaffiliate*beenfound,adjudicated,ordeterminedbyanystatecourt,stateadministrativeagency,including,butnotlimitedto,theIndianaDepartmentofLabor,federalcourtor federalagency,tohaveviolatedorfailedtocomplywithanylaworregulationoftheUnitedStates or anystatewithinthepasttenyears(measuredfromthedateofissuanceofthisRFQ)governingCommonWagesorprevailingwages(includingbutnotlimitedtopaymentforhealthandwelfare,pension,vacation,traveltime,subsistence,apprenticeshiporothertraining, or otherfringe benefits) orovertimecompensation?

YesNo

If yes,pleaseexplain:

8.WithrespecttoeachofQuestions1-7above,ifnotpreviouslyansweredorincludedinapriorresponseonthisform,isanyproceeding,claim,matter,suit,

indictment,etc.currentlypendingagainstthefirmthatcouldresultinthefirmbeing foundliable,guiltyorinviolationofthemattersreferencedinQuestions1-7aboveand/orsubjecttodebarment,suspension,removalordisqualificationbythefederalgovernment,anystateorlocalgovernment,oranyforeigngovernmentalentity?

YesNo

Ifyes,pleaseexplainandprovidetheinformationrequestedastosuchsimilaritems setforthin Questions1-7 above.

*Theterm“affiliate” hasthe meaning setforthinPartB, Section2.6.2 ofthisRFQ.

Underpenaltyofperjury,Icertify that the foregoingistrueandcorrect,andthatIamthefirm’sOfficialRepresentative:

By:

PrintName:

Title:

Date:

[Please makeadditionalcopiesofthisformas needed foreach entityrequired tocompletethisform.]