Attachment D: Certification of Compliance with BSCC Policies Regarding Debarment, Fraud, Theft and Embezzlement Required Attachment: Applicants will be prompted to upload this document from the BSCC CalVIP webpage to the BSCC Submittable Application Portal.
It is the policy of the BSCC to protect grant funds from unreasonable risks of fraudulent, criminal, or other improper use. As such, the Board will not enter into contracts or provide reimbursement to applicants that have been:
debarred by any federal, state, or local government entities during the period of debarment; or convicted of fraud, theft, or embezzlement of federal, state, or local government grant funds for a period of three (3) years following conviction.
Furthermore, the BSCC requires grant recipients to provide an assurance that there has been no applicable debarment, disqualification, suspension, or removal from a federal, state or local grant program on the part of the grantee at the time of application and that the grantee will immediately notify the BSCC should such debarment or conviction occur during the term of the Grant contract.
BSCC also requires that all grant recipients include, as a condition of award to a subgrantee or subcontractor, a requirement that the subgrantee or subcontractor will provide the same assurances to the grant recipient. If a grant recipient wishes to consider a subgrantee or subcontractor that has been debarred or convicted, the grant recipient must submit a written request for exception to the BSCC along with supporting documentation.
By checking the following boxes and signing below, applicant affirms that:
I/We are not currently debarred by any federal, state, or local entity from applying for or receiving federal, state, or local grant funds.
I/We have not been convicted of any crime involving theft, fraud, or embezzlement of federal, state, or local grant funds within the last three (3) years. We will notify the BSCC should such debarment or conviction occur during the term of the Grant contract.
I/We will hold subgrantees and subcontractors to these same requirements.
A grantee may make a request in writing to the Executive Director of the BSCC for an exception to the debarment policy. Any determination made by the Executive Director shall be made in writing.
AUTHORIZED SIGNATURE
(This document must be signed by the person who is authorized to sign the Grant Agreement.)
NAME OF AUTHORIZED OFFICER
TITLE
TELEPHONE NUMBER
EMAIL ADDRESS
STREET ADDRESS
CITY
STATE
ZIP CODE
APPLICANT’S SIGNATURE (Blue Ink or e-signature Only)
DATE
X