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EXHIBIT A <br />CERTIFICATION REGARDING DEBARMENT, SUSPENSION AND OTHER <br />RESPONSIBILITY MATTERS <br />Applicants should refer to the regulations cited below to determine the certification to which they are <br />required to attest. Applicants should also review the instructions for certification included in the <br />regulations before completing this form. Signature of this form provides for compliance with <br />certification requirements under the applicable CFR covering New Restrictions on Government - <br />wide Debarment and Suspension (Nonprocurement). The certification shall be treated as a material <br />representation of fact upon which reliance will be placed when the Agency determines to award the <br />covered transaction or cooperative agreement. <br />As required by Executive Order 12549, Debarment and Suspension, and implemented under the <br />applicable CFR, for prospective participants in covered transactions, as defined in the applicable <br />CFR <br />A. The applicant certifies that it and its principals: <br />(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, <br />sentenced to a -denial of Federal benefits by a State or Federal court, or voluntarily <br />excluded from covered transactions by any Federal department or agency; <br />(b) Have not within a three-year period preceding this application been convicted of or had <br />a civil judgment rendered against them for commission of fraud or a criminal offense in <br />connection with obtaining, attempting to obtain, or performing a public (Federal, State, <br />or local) transaction or contract under a public transaction; violation of Federal or State <br />antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or <br />destruction of records, making false statements, or receiving stolen property; <br />(c) Are not presently indicted for or otherwise criminally or civilly charged by a government <br />entity (Federal State or local) with commission of any of these offenses enumerated in <br />paragraph (1) (b) of this certification; and <br />(d) Have not within a three-year period preceding this application had one or more public <br />transactions (Federal, State or local) terminated for cause or default; and <br />B. WherpAe applicant is unable to certify to any of the statements in this certification, he or <br />she s a 3'Tach an explanation to this application. <br />Agent Signature <br />or Typed Name <br />C 3.±y Manager <br />Title <br />Address:city Hall <br />La Habra, CA 90631 <br />30 <br />