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CITY OF SANTA ANA <br />EXHIBIT H <br />CERTIFICATION REGARDING DEBARMENT <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, that <br />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 organization; <br />b. 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 with <br />obtaining, attempting to obtain, or performing a public (federal, state or local) transaction or <br />contract under a public transaction; violation of federal or state antitrust statues or commission of <br />embezzlement, theft, forgery, bribery, falsification or destruction of records, making false <br />statements, or receiving stolen property. <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 enumerated in paragraph (1)(b) of <br />this certification; and <br />d. Have not within a three-year period preceding this application/proposal had one or more public <br />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 />QM_KVk& C 6\A� s ty, A,;i,, G Caur�) <br />0 Grantee/C ntractorOrganization" <br />Name and Title of Official Authorized to Certify <br />On Behalf of the Grantee <br />of /05/?Q3 <br />Date <br />74 <br />