1-Certification of Non-Debarment PDF.pdf
PDF 123 KB Posted
- Attached to
- iRFP Every Door Direct Mail (EDDM) Services
- Solicitation number
- 25-06880
- Issued by
- San Bernardino County, California
About this file
This is a Certification of Non-Debarment document required by the Inland Empire Health Plan (IEHP) for the Every Door Direct Mail (EDDM) Services contract opportunity in California. The certification attests that the bidding firm, company, or sole proprietorship is not excluded, ineligible, or terminated from participation in State or Federal health care programs and does not appear on exclusion lists maintained by the Department of Health & Human Services Office of Inspector General, the General Services Administration System for Award Management, the California Department of Health Care Services Medi-Cal Suspended and Ineligible Provider List, or the Medicare Opt-Out List. The document requires execution by an authorized representative of the prospective contractor and serves as binding certification of compliance with these requirements.
The contractor executing this certification must commit to conducting regulatory sanction and exclusion screenings of any subcontracted entities prior to initial engagement and on a monthly basis thereafter. The document explicitly states that any contractor that becomes excluded, ineligible, or terminated from participation in State and Federal health care programs during the contract term will be subject to immediate termination for cause by IEHP. This certification is a mandatory compliance requirement for participation in the EDDM campaign to promote Colorectal Cancer screening events across San Bernardino and Riverside counties.
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Text version
Certification of Non-Debarment
CERTIFICATION
As an authorized representative of my Firm/Company/Sole Proprietorship, I hereby attest that my Firm/Company/Sole Proprietorship is not excluded, ineligible, or terminated from participation in State or Federal health care programs and does not appear on any of the following lists:
a. The Department of Health & Human Services (DHHS), Office of Inspector General (OIG), and List of Excluded Individuals and Entities (LEIE). Please visit https://exclusions.oig.hhs.gov.
b. General Services Administration (GSA), and the System for Award Management (SAM.gov). Please visit https://www.sam.gov.
c. California Department of Health Care Services (DHCS), and Medi-Cal Suspended and Ineligible Provider List (S&I List). Please visit http://files.medical.ca.gov/pubsdoco/SandILanding.asp.
d. Medicare Opt-Out List. Please visit https://data.cms.gov/dataset/Opt-Out- Affidavits/7yuw-754z.
I further attest that if selected, my Firm/Company/Sole Proprietorship will conduct regulatory sanction and exclusion screenings of subcontracted entities prior to engagement with said entities and monthly thereafter.
I understand that if my Firm/Company/Sole Proprietorship becomes excluded, ineligible, or terminated from participation in State and Federal health care programs, any contracts held with IEHP will be subject to immediate termination for cause.
RFP Name/Number:
Signature: Date:
Title of Agent/Officer:
"Execution hereof is certification that the undersigned has read and understands the terms and conditions hereof, and that the undersigned's principal is fully bound and committed."
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