10-1002HVAC Vendor Debarment Statement.pdf
PDF 73 KB Posted
- Attached to
- CNS POINT OF SALES DISTRICT WIDE
- Solicitation number
- 1072CNPS
- Issued by
- Victoria County, Texas
About this file
This document is a Vendor Debarment Statement required by school districts in the State of Texas, specifically related to a procurement process involving Executive Order 12549 on Debarment and Suspension. The form requires a vendor to certify that their company has not been debarred or suspended from conducting business with Texas school districts, in compliance with federal regulations published in the January 30, 1989 Federal Register.
The statement is a self-certification document that must be completed by a company representative, requiring details such as the company name, mailing address, contact information, and an authorized signature. The form provides an option to indicate any changes in address or telephone number, and references specific regulatory guidelines including 7 CFR Part 3017, Section 3017.510 regarding participants' responsibilities. Vendors can obtain copies of the full regulation by contacting the originating Department of Agriculture Agency.
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Text version
Attachment i.
VENDOR DEBARMENT STATEMENT
I have read the conditions and specifications provided in the proposal document attached.
I affirm, to the best of my knowledge, the company I represent has not been debarred or suspended from conducting business with school districts in the State of Texas. This certification is required by the regulations implementing Executive Order 12549, Debarment and Suspension, 7 CFR Part 3017, Section 3017.510, Participants’ responsibilities. The regulations were published as Part IV of the January 30, 1989, Federal Register (pages 4722-4733). Copies of the regulation may be obtained by contacting the Department of Agriculture Agency with which this transaction originated.
NAME OF COMPANY (Please Type)
MAILING ADDRESS CITY STATE ZIP
PREPARED BY (Please Type)
SIGNATURE TITLE
TELEPHONE NUMBER FAX NUMBER DATE
Check here if you have an address or telephone number change: Yes____ No____
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