Agenda Packet_2023-10-17 - Laserfiche WebLink

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EXHIBIT B CERTIFICATION REGARDING DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY MATTERS Applicants should refer to the regulations cited below to determine the certification to which they are required to attest. Applicants should also review the instructions for certification included in the regulations before completing this form. Signature of this form provides for compliance with certification requirements under the applicable CFR covering New Restrictions on Goverent-wide Debarment and Suspension (Nonprocurement). The certification shall be treated as a material representation of fact upon wliicli reliance will be placed when the Agency determines to award the covered transaction or cooperative agreement. As required by Executive Order 12549, Debarment and Suspension, and implemented under tlie applicable CFR, for prospective participants in covered transactions, as defined in the applicable CFR A. The applicant ceitifies that it and its principals: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, sentenced to a denial of Federal benefits by a State or Federal court, or voluntarily excluded from covered transactions by any Federal department or agency; (b) Have not within a three-year period preceding tliis application been convicted of or had a civil judgment rendered against tliem for cominission of fraud or a criminal offense in connection with obtainiiig, attempting to obtain, or perfonning a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antiti-ust statutes or conunission of embezzlement, tlieft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (c) Are not presently indicted for or otherwise criminally or civilly charged by a governirient entity (Federal State or local) witli commission of any of these offenses enumerated in paragrapli (1) (b) of this certification; and (d) Havenotwithinathree-yearperiodprecedingthisapplicationhadoneormorepublictransactions (Federal, State or local) tenninated for cause or default; and B. Where the applicant is unable to certify to any of the statements in this certification, he or slie shall attach an explanation to this application. Address: 5AA/?/1 fi!VA PoQCt 1')EPmT#'Vfl7 Autho ture DAVlb VAuA/71A/ Printed or Typed Name 60 cxyzc ctitrtx PL2 (JLTEF OF POllct Title Spma wA, CA 'Uqoi City Council 24 – 44 10/17/2023