STATEMENT OF NON-DEBARMENT

Debarment:

I _____________________________, representing _____________________________,

(Company Official) (Company)

do hereby state that _____________________________________ is not debarred,

(Company)

suspended, or otherwise prohibited from providing construction services by any Federal,

State or local agency.

Contract Completion:

I _____________________________, representing _____________________________,

(Company Official) (Company)

do hereby state that _____________________________________ has not been stopped

(Company)

by any Owner from completing a contracted project for cause.

___________________________________ _____________________________
Company Official Signature Date

NOTARY PUBLIC SEAL

Witnessed this day, _________________________ By ___________________________

My commission expires on _________________________________________________