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CERTIFICATION REGARDING DEBARMENT AND SUSPENSION <br />By signing and submitting this proposal, the applicant, defined <br />as the primary participant in accordance with 4S CFA Part 76, <br />certifies to the best of its knowledge and belief that it and its prin- <br />cipals: <br />(a) are not presently debarred, suspended, proposed for debar- <br />ment, declared ineligible, or voluntarily excluded from covered <br />transactions by any Federal Department or agency; <br />(b) have not within a 3-year period preceding this proposal been <br />convicted of or had a civil judgment rendered against them for <br />commission of fraud or a criminal offense in connection with o- <br />btaining, attempting to obtain, or performing a public (Federal. <br />State, or local) transaction or contract under a public transaction; <br />violation of Federal or State antitrust statutes or commission of <br />embezzlement, theft, forgery, bribery, falsification or destruction <br />of records, making false statements, or receiving stolen property; <br />It) are not presently indicted or for otherwise criminally or civilly <br />charged by a governmental entity (Federal, State, or local) -with <br />Orange Cvamty Health DVarbnmt <br />Name of gency <br />Moses Carev <br />Signature ot AUtnorized ilia <br />W <br />commission of any of the offenses enumerated in paragraph (1)(b) <br />of this certification; and <br />(d) have not within a 3 -year period preceding this applica- <br />tion /proposal had one or more public transactions (Federal, State, <br />or local) terminated for cause or default. <br />The applicant agrees that by submitting this proposal, it will in- <br />clude without modification the clause entitled "Certification <br />Regarding Debarment, Suspension. Ineligibility, and voluntary Ex- <br />clusion - Lower Tier Covered Transactions," i.e., with subgrantees <br />or contractors. in all lower tier covered transactions and in all solic- <br />itations for lower tier covered transactions in accordance with 45 <br />CFR Part 76. <br />Should the applicant not be able to provide this certification, an <br />explanation as to why should be placed after the assurances page <br />in the application package. <br />