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y <br /> ' CITY OF SANTA ANA <br /> ATTACHMENT H <br /> CERTIFICATE REGARDING DEBARMENT,SUSPENSION, INEGIBILITY 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 ware 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 focal)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 /> Consultant <br /> �L � <br /> Stephen H.Heil <br /> URTA LLC/Managing Partner <br /> _O Name and Title of Official Authorized to Certify <br /> n Behalf of the Consultant <br /> THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. <br /> PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPOIVSIWE. <br /> Date <br /> INSTRUCTION FOR CERTIFICATION <br />