SPEECH THERAPY SERVICES

*Add additional sheets if necessary** OR   The Organization listed above in Part I does not own greater than 50 percent of the voting stock in any corporation and does not own greater than 50 percent interest in any partnership or any limited liability company. Section B (skip if no business entities are listed in Section A of Part IV)  Below are the names and addresses of any entities in which an entity listed in Part III A owns greater than 50 percent of the voting stock (corporation) or owns greater than 50 percent interest (partnership or limited liability company). Name of Business Entity Controlled by Entity Listed in Section A of Part IV Business Address **Add additional Sheets if necessary** OR  No entity listed in Part III A owns greater than 50 percent of the voting stock in any corporation or owns greater than 50 percent interest in any partnership or limited liability company. Section C – Part IV Certification I hereby certify that the Organization listed above in Part I does not own greater than 50 percent of any entity that that is debarred by the federal government from contracting with a federal agency and, if applicable, does not own greater than 50 percent of any entity that in turns owns greater than 50 percent of any entity debarred by the federal government from contracting with a federal agency. I further acknowledge: that I am authorized to execute this certification on behalf of the above-named organization; that the Franklin Township Board of Education is relying on the information contained herein and that I am under a continuing obligation from the date of this certification through the date of contract award by the Board to notify the Board in writing of any changes to the information contained herein; that I am aware that it is a criminal offense to make a false statement or misrepresentation in this certification, and if I do so, I am subject to criminal prosecution