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Agenda Packet_2023-02-07
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Agenda Packet_2023-02-07
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7/27/2023 2:36:37 PM
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City Clerk
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Agenda Packet
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Clerk of the Council
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2/7/2023
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(2) <br />CITY OF SANTA ANA <br />ATTACHMENT H <br />CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY AND <br />VOLUNTARY EXCLUSION LOWER TIER COVERED TRANSACTIONS <br />This certification is required by the regulations implementing Executive Order 12549, Debarment and <br />Suspension, 29 CFR Part 98, Section 98.510, Participants' responsibilities. The regulations were published <br />as Part VI of the May 26, 1988 Federal Register (pages 19160-19211). <br />(BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS FOR CERTIFICATION —on following <br />page) <br />(1) The prospective recipient of federal assistance funds certifies, by submission of this proposal, that <br />neither it nor its principals are presently debarred, suspended, proposed for debarment, declared <br />ineligible, or voluntarily excluded from participation in this transaction by any federal department or <br />agency. <br />(2) Where the prospective recipient of federal assistance funds is unable to certify to any of the <br />statements in this certification, such prospective participant shall attach an explanation to this <br />proposal. <br />Name and Title of Authorized Representative <br />Signature <br />Date <br />THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. <br />PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE. <br />City Council 22 — 53 2/7/2023 <br />
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