Ensuring compliance and maintaining the integrity of transactions within the United States Department of Agriculture (USDA) programs and activities is essential, which is where the AD-1048 form plays a pivotal role. This electronically available form, backed by an OMB Approval Number 0505-0027 and with a current expiration date of December 31, 2018, acts as a Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion for Lower Tier Covered Transactions. Crafted under the regulations executed by Executive Order 12549 on Debarment and Suspension, and further detailed in 2 C.F.R. §§ 180.300, 180.355, it lays out stringent guidelines and responsibilities for participants. The form not only assures adherence to privacy act considerations but also highlights the requirement for participants to disclose their eligibility status in regards to debarment or suspension by any Federal department or agency. Key elements include the necessity for organizations or individuals to certify their status before engaging in covered transactions and to promptly notify relevant parties of any change in their certification status. Additionally, it covers the vital aspects of ensuring nondiscrimination and providing equal opportunity in all USDA programs, reaffirming USDA's commitment to fair and equal treatment for all, aside from detailing the procedural steps and implications associated with the certification. This comprehensive document serves not just as a form but as a testament to the USDA's dedication to integrity, transparency, and accountability in its engagements.
| Question | Answer |
|---|---|
| Form Name | Form Ad 1048 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | rd ad 1048, 1048 certification form, form ad 1048 certification regarding debarment, fillable 1048 form |
This form is available electronically. |
Form Approved – OMB No. |
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Expiration Date: 12/31/2018 |
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United States Department of Agriculture |
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Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion
Lower Tier Covered Transactions
The following statement is made in accordance with the Privacy Act of 1974 (5 U.S.C. § 552(a), as amended). This certification is required by the regulations implementing Executive Order 12549, Debarment and Suspension, and 2 C.F.R. §§ 180.300, 180.355, Participants' responsibilities. The regulations were amended and published on August 31, 2005, in 70 Fed. Reg.
According to the Paperwork Reduction Act of 1995 an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is
(Read Instructions On Page Two Before Completing Certification)
A.The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency;
B.Where the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal.
ORGANIZATION NAME |
PR/AWARD NUMBER OR PROJECT NAME |
NAME(S) AND TITLE(S) OF AUTHORIZED REPRESENTATIVE(S)
SIGNATURE(S)
DATE
The U.S. Department of Agriculture (USDA) prohibits discrimination in all of its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, political beliefs, genetic information, reprisal, or because all or part of an individual’s income is derived
from any public assistance program. (Not all prohibited bases apply to all programs). Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202)
Assistant Secretary for Civil Rights, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, S.W., Stop 9410, Washington, DC
(866)
Instructions for Certification
(1)By signing and submitting this form, the prospective lower tier participant is providing the certification set out on page 1 in accordance with these instructions.
(2)The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was entered into. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies, including suspension or debarment.
(3)The prospective lower tier participant shall provide immediate written notice to the person(s) to which this proposal is submitted if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.
(4)The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered transaction," "participant," "person," "primary covered transaction," "principal," "proposal," and "voluntarily excluded," as used in this clause, have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549, at 2 C.F.R. Parts 180 and 417. You ma y contact the department or agency to which this proposal is being submitted for assistance in obtaining a copy of those regulations.
(5)The prospective lower tier participant agrees by submitting this form that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the department or agency with which this transaction originated.
(6)The prospective lower tier participant further agrees by submitting this form that it will include this clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions," without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.
(7)A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the System for Award Management (SAM) database.
(8)Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.
(9)Except for transactions authorized under paragraph (5) of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, the department or agency with which this transaction originated may pursue available remedies, including suspension and/or debarment.
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