CERTIFICATION STATEMENT Under the provisions ofthe United States Department of Agriculture, Food and Nutrtion Service, 7 CFR Part 226.6 Fequitements for institutions participating in the Child and Adult Care Food Program: | certify, 28 an applicant institution, the information submitted to the llinois State Board of Education is true and ‘correct and this institution wil comply withthe rights and responsibilties outlined in the Permanent Agreement. certify that nether the institution nor any ofits key individuals has been convicted during the past seven years of any activities that indicate a lack of business integrity. Lack of business integrity includes fraud, antitrust violations, smbezziement, thet forgery, bribery, falsification or destruction of records, making false siatements, receiving stolen property, making false clams, obstruction of justice, or any other activites indicating @ lack of business inlogny a \ defined by the State Agency. oS RENTS a ro pclae cad on hs CACEP Hana Dap Lit (rhlonmnonan ain | certify, no sponsored facility or principal of a sponsored facility is currently on the CACFP National Disqualified List (for sponsoring organizations only) | cerity, the Institution is currently compliant with the required performance standards of financial viability and ‘management, administrative capabilty, and program accountablity as described in 7 CFR 226.6(b)(2Kv) | certify the institution has not been disqualified from participation in any other publicly-funded program for violating that program's requirements in the past seven years, | understand this information is being given in connection with the receipt of Federal funds and deliberate ‘misrepresentation may subject me to prosecution under applicable state and Federal criminal statutes,