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i <br /> CITY OF SANTA ANA <br /> ATTACHMENT <br /> CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY, AND <br /> VOLUNTARY EXCLUSION <br /> This certification is required by the regulations implementing Executive Order 12549, as amended, <br /> Nonprocurement Debarment and Suspension, 2 CFR Part 2998, Subpart C, Responsibilities of <br /> Participants Regarding Transactions.The regulations were published as Part VII of the May 26, 1988, <br /> Federal Register(Pages 19160-19211), and as subsequently amended in 81 Federal Register 25585. <br /> (Before completing certification, read instructions which are an integral part of certification) <br /> 1. Pursuant to 2 CFR 180.335, the prospective primary participant, (i.e. grantee) certifies to the best of <br /> its knowledge and belief, that it and its principals: <br /> a. Are not presently excluded or disqualified; <br /> b. Have not been convicted within the preceding three years of any of the offenses listed in <br /> 2CFR 180.800(a) or had a civil judgment rendered against them for one of those offenses within <br /> that time period. <br /> c. Are not presently indicted for or otherwise criminally or civilly charged by a government entity <br /> (Federal, State or local)with commission of any of the offenses listed in 2 CFR 180.800(a); and <br /> d. Have not had one or more public transactions (Federal, State or local) terminated within the <br /> preceding three years for cause or default. <br /> 2. Where the prospective primary participant is unable to certify to any of the statements in this <br /> certification, such prospective participant shall attach an explanation to this proposal. <br /> x&gn � mf C�rt�ux� LLC <br /> Consultant <br /> k', U'fii>< WO'" ,CO <br /> Name aid Title of Official Authorized to Ce ify <br /> On Behalf of the Consultant <br /> bate <br /> THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. <br /> PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE. <br />