IRVINE, CITY OF (7) -2015 - Laserfiche WebLink

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CERTIFICATION REGARDING DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY MATTERS Applicants should refer to the regulations cited below to determine the certification to which they are required to attest. Applicants should also review the instructions l'or certification included in the regulations before completing this form. Signature of this form provides for compliance with certification requirements under the applicable CFR covering New Restrictions on Government -wido Debarment and Suspension (Nonprocurement). The certification shall be treated as a material representation of fact upon which reliance will be placed when the Agency detennines to award the covered transaction or cooperative agreement As required by EXeeUdiVe Order 12549, Debarment and Suspension, and implemented under tire applicable CFR, for prospective participants in covered transactions, as defined in the applicable CFR A. The applicant certifies that it and its principals: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, sentenced to a denial of Federal benefits by a State or Federal court, or voluntarily excluded from covered transactions by any Federal department or agency; (b) Have not within a three -year period preceding this application been convicted of or had a civil judgment rendered against then for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a. public (Federal, State, or local) transaction or contract tinder a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (c) Are riot presently indicted for or otherwise criminally or civilly charged by a government entity (Federal State or local) with commission of any of these° offenses enumerated in paragraph ( I ) (b) of this certification; and (d) Have not within a three -year period preceding this application had one or more public transactions (Federal, State or local) terminated for cause or default; and B. Where the applicant is unable to certify to any of the staements in this certification, lie or she shall attach an el anation to this application. Address: _ -1 Civic Center Plaza Authodzod Agent Signature Mike Hamel Irvine, CA 92606 Printed or Typed Name Director of Public Safety pitle 27