I hereby certify that I am an authorized representative of the business named above, with
the authority to commit the business to legally binding contracts and agreements. I
further certify that the information given as part of this application is true and
accurate. I am aware that any false information or intended omissions may subject me to
civil or criminal penalties for the filing of false public records and/or forfeiture of
any funds approved through this program.
This application does not constitute a contractual agreement. If any portion of the
application is approved, a formal agreement between parties will be executed to obligate
funds for the approved expenditures. Activities may not start prior to the effective
date of the agreement.
By signing this application, I certify that I am authorized to enter into an agreement
with the Orange County that includes my representation, warranty and covenant that I am
eligible to receive federal funding, my organization is in good standing with the State
of California, Unemployment Insurance (UI) taxes and are in good standing and I agree to
submit receipts for all purchases made with funding received and provide acceptable
form(s) of valid government-issued photo ID (state, domestic, or foreign) and
documentation that includes the owner’s name and may include but is not limited to the
following: a local business permit or license, a bank statement, a tax return, a trade
account and Third-party verification.