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Certification Regarding <br />Debarment, Sus pension, Ineli�ibiliri� and �'oluntary Exclusion <br />Lower Tier Covered Transactions <br />This certification is required b� the regulations implementing Executive Order 12".4 - <br />Debarment and Suspension. �� CFR Part 98. Section 98.10. Participants' P�esponsibiliues. The <br />n:2ulations were publisile'd as Part Vil of the MLIv 16. 1988_ Federal Register ("Pages 1 9 <br />i U1611- <br />� 1 1 �. <br />ifi <br />(Before completing certcation, read instructions which are an integral part of certification) <br />t (i.e. grantee � certifies to the best of its <br />1. The prospective primary participanl i�o��'ledge and <br />belief. that it and its principals: <br />a. are not presently debarred. suspended. proposed for debarment. declared ineligible. or <br />voluntarily excluded from covered transactions b,, an, federal department or agency_ <br />b. Have not within a three -,ear period preceding this proposal been convicted or had a <br />civil judgment rendered against them for commission of fraud or a criminal offense in <br />connection «-ith obtaining. attempting to obtain. or performing a public (federal. state or <br />local) transaction or contract under a public transaction_ violation of federal or state <br />antitrust statues or cormission of embezzlement. theft, forger}. bribery falsification or <br />destruction of records. malting false statements. or receiving stolen propem. <br />c. Arc not present)- indicted for or otherwise criminally or civillN charged by a <br />,novernment entity (federal. state or local ) with commission of and of the offenses <br />enumerated in paragraph (1 0) of this certification: and <br />d. Have not within a three-year period preceding this application/proposal had one or <br />more public transactions (federal. state or local) terminated for cause or default. <br />2. where the prospective primar,, participant is unable to certi . to an <br />of the statements in this <br />cerufrcatiorn, such prospective participant shall attach an explanation to this proposal. <br />Oran(e Count-v Children's Therapeutic Arts Center (OCCTAC) <br />Grantee/Contractor Organization <br />_ r <br />Dr.01a'Jimenez-Ha �aecutive ll ecto► <br />Name and Title of Official Authorized to Certifv <br />On Behalf of the Grantee <br />Mav 18, 2008 <br />Date <br />