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CERTIFICATION REGARDING <br />DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS <br />PRIMARY COVERED TRANSACTIONS <br />This certification is required by the regulations implementing <br />Executive Order 12549, Debarment and Suspension, 45 CFR Part 1229, <br />Section 1229.510, Participants' responsibilities. The regulations <br />were published as Part VII of the May 26, 1988 Federal Re inter <br />(pages 19160 - 19211). <br />(BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS ON REVERSE) <br />1. The prospective primary participant certifies to the best of <br />its knowledge and belief, that it and its principals: <br />a. Are not presently debarred., suspended, proposed for <br />debarment, declared ineligible, or voluntarily excluded <br />from covered transactions by any Federal department or <br />agency; <br />b. Have not within a three -year period preceding this <br />proposal been convicted of or had a civil judgment <br />rendered against them for commission of fraud or a <br />criminal offense in connection with obtaining, attempting <br />to obtain, or performing a public (Federal, state or <br />local) transaction or.-contract under a public transaction; <br />violation of Federal or'State antitrust statutes or <br />commission of embezzlement, theft, forgery, bribery, <br />falsification or destructign of records, making false <br />statements, or receiving stolen property; <br />c. Are not presently indicted for or otherwise criminally or <br />civilly charged by a government entity (Federal, State or <br />local) with commission of any of the offenses enumerated <br />in paragraph l.b. of this certification; and <br />d. Have not within a three -year period preceding this <br />application /proposal had one or more public transactions <br />(Federal, State or local) terminated for cause or default. <br />2. Where the prospective primary participant is unable to certify <br />to any of the statements in this certification, such <br />prospective participant shall attach an explanation to this <br />proposal, <br />Moses Carey,. Chair, Orange County Commissioners <br />Name And Title Of Authorized Representative <br />0 Signature Date <br />18. <br />xcnm roan % -1455 ici19j <br />