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25B - AGMT - MOU YOUTH SERVICE PROVIDERS
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25B - AGMT - MOU YOUTH SERVICE PROVIDERS
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Last modified
6/1/2017 3:32:44 PM
Creation date
6/1/2017 3:13:21 PM
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City Clerk
Doc Type
Agenda Packet
Agency
Community Development
Item #
25B
Date
6/6/2017
Destruction Year
2022
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Certification Regarding <br />Debarment, Suspension Ineligibility and Voluntary Exclusion <br />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 <br />published as Part VII of the May 16, 1988, Federal Register (Pages 19160-19211), <br />(Before completing certification, read instructions which are an integral part of certification) <br />1. The prospective primary participant, (i.e, grantee) certifies to the best of its knowledge and belief, <br />that it and its principals: <br />a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or <br />voluntarily excluded from covered transactions by any federal department or agency; <br />It. Have not within a three-year period preceding this proposal been convicted or had a civil <br />judgment rendered against them for commission of fraud or a criminal offense in connection <br />with obtaining, attempting to obtain, or performing a public (federal, state or local) transaction <br />or contract under a public transaction; violation of federal or state antitrust statues or <br />commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, <br />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 the offenses enumerated in paragraph <br />(1)(b) of this certification; and <br />d. Have not within a three-year period preceding this application/proposal had one or more <br />public transactions (federal, state or local) terminated 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 />Orange County Children's Therapeutic Arts Center <br />Grantee/Contractor Organization <br />Name and Title of Official Authorized to certify <br />Signature of Official Authorized to Certify Date <br />EXHIBIT F <br />r <br />
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