00 45 07_Public Contractor Debarment Form.pdf

PDF 144 KB Posted

Attached to
Acushnet River Rowing Floating Dock
Solicitation number
26650045
Issued by
Bristol County, New Bedford City, Massachusetts

About this file

This document is a Public Contractor Debarment form from the City of New Bedford, issued under Mayor Jonathan F. Mitchell. The form is a certification document that requires a contractor to affirm they are not currently debarred from performing public construction work in the commonwealth under specific provisions of Massachusetts General Laws.

The form provides space for a contractor to complete their contact information, including signature, printed name, company name, date, title, telephone, fax, and email. The certification requires the contractor to declare under penalty of perjury that they are not presently prohibited from conducting public construction work, referencing section twenty-nine F of chapter twenty-nine and other applicable debarment provisions in the General Laws or associated regulations.

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Text version

City of New Bedford Mayor Jonathan F. Mitchell

PUBLIC CONTRACTOR DEBARMENT

The undersigned certifies under penalty of perjury that the below named contractor is not presently debarred from doing public construction work in the commonwealth under the provisions of section twenty-nine F of chapter twenty-nine, or any other applicable debarment provisions of any other chapter of the General Laws or any rule or regulation promulgated thereunder.

Contractor Authorized Signature

Printed Name

Date

Title_______________________ Telephone:_________________

Fax:________________________ Email:____________________

Company Name

La st

M od ifi ed

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Design Section 00 45 07

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