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7.1.A. - Page 49 <br /> BID SOLICITATION FOR LED STREET LUMINAIRES <br /> ATTACHMENT C — EXCLUDED PARTIES SELF - CERTIFICATION <br /> By signing this document, I certify the following; <br /> 1. Please select and complete one of the following: <br /> Dealership or business: I affirm that neither ACv %fl * c ATI c' ' ' " <br /> (business name) nor any of the principals of At V % rte AAA A-+ .A P`' 7---1.2e-en-e- a— & <br /> (business name) are identified on the EXCLUDED PARTIES LIST SYSTEM (EPLS), as identified <br /> on the System for Award Management website, www.sam.gov. <br /> ❑ Individual's dba as a business: I affirm that <br /> (responsible party(s)) am /are not identified on the EXCLUDED PARTIES LIST SYSTEM (EPLS), <br /> as identified on the System for Award Management website, www.sam.gov. <br /> ❑ Public entity: I affirm that _ (public entity) is <br /> not identified on the EXCLUDED PARTIES LIST SYSTEM (EPLS), as identified on the System <br /> for Award Management website, www.sam.gov. <br /> Signed, <br /> C-7 s 447 <br /> Authorized Signature & Title Date <br /> P `-0 (.t . PA--fro S r C�2 2r of <br /> Authorized Signatory Name & Title (print) <br /> C -r4 ( e 7 c L t [p 7 A4 Cr <br /> Com pany /Agency Name <br /> Street Address, City, State, Zip Code <br /> PUBLIC WORKS DIVISION 15 <br /> 2013 -2014 LED Street Luminaires <br />