LAEDC x South Valley Worksource Center Business Expo Registration

The Economic Mobility Initiative (EMI) is funded by American Rescue Plan Act federal funding administered by the LA County Department of Economic Opportunity (DEO) with support from the Los Angeles County Economic Development Corporation (LAEDC). The Economic Mobility Initiative is your no-cost partner in starting and growing your dream venture. We empower LA County small business owners, entrepreneurs, and nonprofits by providing tailored support that helps you thrive and build generational wealth in your communities.

Please complete this self-attestation form to enable EMI partners to determine eligibility for services.

1. I verify and affirm that within the prior three years, I have neither been convicted of, nor have I had a civil judgment rendered against me, nor have I commenced any form of parole or probation, including probation before judgment, for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a Federal, State, County, or local public transaction or contract under a public transaction, violation of federal or state antitrust or procurement statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property. I verify and affirm that I am not presently indicted for, or otherwise criminally or civilly charged by, a federal, state, or local government entity, with commission of any of the offenses enumerated above.

2. I verify and affirm that I have not been suspended, disbarred, made ineligible, or excluded from participation in Federal, State, County, or local financial or nonfinancial assistance programs, benefits, contracts, subcontracts, loans, or grants. This includes owners/officers of the business/nonprofit as well as the business/nonprofit itself and its related subsidiaries.

3. I verify and affirm that neither I, nor my business/nonprofit, am in LA County's Contractor Alert Reporting Database (CARD), which uses the County's existing enterprise-based eCAPS System to track poorly performing contractors. To view the current listing of Contractors debarred in Los Angeles County, please visit: https://procurement.lacounty.gov/contractors-debarred/

4. I verify and affirm that my business/nonprofit is currently, and was, during the period for which the business/nonprofit is claiming the economic impact from the COV/0-19 pandemic, physically located and operating within the County of Los Angeles. I further acknowledge that the COV/0-19 Vulnerability and Recovery Index "Need Tier" will be determined based on my current business/nonprofit address or home address reported which is true and accurate to the best of my knowledge.

5. I verify and affirm that my business/nonprofit was registered to do business legally in the state of California and/or any other applicable jurisdiction prior to December 30, 2021, as determined by registration with the California Secretary of State or government-issued, active business/nonprofit license or permit. I further verify and affirm that my business/nonprofit is an active business/nonprofit currently in operation, and that it is in good standing with all local, state, and federal taxing and licensing authorities.

6. I verify and affirm that my business/nonprofit is not, and cannot be defined as one or more of the following types of organizations deemed ineligible to participate in this program:

a. Religious organization or church.
b. Government office or agency.
c. Publicly traded company.
d. Corporate-owned franchise.
e. Financial institution, such as a bank, lender, pay day lender, auto title lender, check casher, or other business/nonprofit whose stock in trade is money and mortgages, and other similar entities.
f. Insurance company, such as life, auto, home, bail bond, or another similar entity.
g. Private or social club.
h. Pawn shop.
i. Business/nonprofit providing astrology or palm reading.
j. Liquor store or night club.
k. Lobbying firm or business/nonprofit who dedicates fifty percent {50%) or more of its time or resources to lobbying activities.
I. Business/nonprofit that engages in gambling activities, such as a bingo parlor or a casino.
m. Adult bookstore or business/nonprofit that presents live performances of a sexual nature.
n. Business/nonprofit that generates income through activities performed in violation of state or federal law, including the sale, cultivation, or transportation of marijuana.
o. Business/nonprofit that exists for the purpose of advancing partisan political activities.
p. Gun or ammunition store

7. I verify and affirm that my business/nonprofit experienced negative economic impacts from the COVID-19 pandemic from March 03, 2021 to the present.

8. I verify and affirm that I agree to cooperate with LA County and any of its employees, contractors, subrecipients, or other designees, and will provide any further information, verifications, or paperwork that may be required to authorize services under this program.

9. I verify and affirm that if I, or my business/nonprofit, have contracted with LA County in the past, that neither I, nor my business/nonprofit, currently owe the County money and I am neither in current, nor prior litigation with the County over a previous contract with the County.

10. I verify and affirm that my business/nonprofit is independently owned and operated.

I declare under penalty of perjury under the laws of the State of California that theforegoing is true and correct. I further understand that if I make false statements or false representations, or provide misleading or incomplete information to the County with regard to receiving services related to LA County's Economic Mobility Initiative, this may result in my disqualification from the program, and I may be subject to civil liability and penalties, be required to repay LA County for any services received while deemed ineligible, and I could be excluded or barred from participating in other County programs.

Additionally, I declare that I am a resident of LA County, my business/nonprofit is located in LA County, and all the above statements are true and correct.