Eligibility Verification

Date of Eligibility Verification: __________________

Bidder No. 1

Bidder No. 2

Bidder No. 3

Bidder No. 4

World Bank Debarred List http://worldbank.org/debarr Not in the list Not in the list Not in the list Not in the list

System for Award Management (Excluded Parties List) https://www.sam.gov/SAM/pages/public/searchRecords/search.jsfUS Government Consolidated Screening List1

https://www.export.gov/csl-searchState Sponsors of Terrorismhttps://www.state.gov/j/ct/list/c14151.htmEligibility confirmed Legend: E = Eligible / NE = Not Eligible

1 Includes U.S. Treasury, SDN, Commerce Denied Persons List, Entity List, State Dept. DTC, Terrorist Designations and State Sponsors of Terrorism 2 – For specific instructions please visit MCC Procurement Guidance Note:Excluded Parties Verification Procedures in MCA Entity Program Procurements