10-1002HVAC Vendor Debarment Statement.pdf
PDF 73 KB Posted
- Attached to
- CNS Disposal Serive State and local contract opportunity
- Solicitation number
- 1074CNDS
- Issued by
- Van Zandt County, Texas
About this file
The document is a Vendor Debarment Statement form related to business transactions with school districts in the State of Texas. 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 Executive Order 12549, Debarment and Suspension regulations (7 CFR Part 3017, Section 3017.510). The form requires the vendor to provide company name, mailing address, contact information, and an authorized signature affirming their compliance status.
The document is a standard certification form that vendors must complete when participating in school district procurement processes in Texas. It references specific federal regulations published in the January 30, 1989 Federal Register, and provides instructions for obtaining copies of the relevant regulatory documentation from the Department of Agriculture Agency. The form includes fields for the vendor to indicate any changes to their address or contact information, and serves as a legal attestation of the company's good standing for business transactions with educational institutions.
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Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| 1-1002HVAC Bid Sheet.pdf | ||
| 15-1003INSU Specifications.pdf | ||
| 7-1002HVAC Anti-Terrorism Certification.pdf | ||
| 14-1003INSU Addendum 1.pdf | ||
| 3-1002HVAC Non-Collusive Certificate.pdf | ||
| 4-1002HVAC Felony Conviction Notification.pdf | ||
| 6-1002HVAC Form 1295.pdf | ||
| 9-1002HVAC Lobbying Certification.pdf | ||
| 5-1002HVAC Form CIQ.pdf | ||
| 8-1002HVAC Tex Govt Code 2270 Verification.pdf | ||
| 11-1002HVAC Certificate of Residency.pdf | ||
| 12-1002HVAC HUB or Minority Owned Business.pdf | ||
| 13-1002HVAC W-9 Form.pdf | ||
| 16-1003INSU Questionnaire 2022.pdf | ||
| 2-1002HVAC Deviations Form.pdf |
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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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