10-Debarment and Suspension Certification - Form.pdf
PDF 51 KB Posted
- Attached to
- Trucks: Dump Trucks and Haul Truck
- Solicitation number
- FS-01-26
- Issued by
- Upshur County, Texas
About this file
This is a Debarment and Suspension Certification form required by the City of San Angelo, Texas Purchasing Division for a trucks procurement opportunity seeking to purchase approximately 2 dump trucks and 1 haul truck within the first 12 months of contract award, with second-year quantities to be determined. The certification applies to prospective primary vendors bidding on this opportunity.
The form requires vendors to certify that they and their principals are not debarred, suspended, proposed for disbarment, or voluntarily excluded from covered transactions by any Federal department or agency. Vendors must also confirm they have not been convicted of fraud, criminal offenses, or civil judgments related to public transactions within the three-year period preceding the application; are not currently indicted or criminally or civilly charged with relevant offenses; and have not had public transactions terminated for cause or default within the three-year period preceding the application. Vendors unable to certify to any statement must attach an explanation to their bid. The form requires an authorized agent signature, printed vendor name, title, and date of certification.
View the file
Other files
Show all 14
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
CITY OF SAN ANGELO, TEXAS
PURCHASING DIVISION
72 West College Avenue, San Angelo, Texas 76903
325.657.4219 • sapurch@cosatx.us
CITY OF SAN ANGELO, TEXAS • DEBARMENT AND SUSPENSION CERTIFICATION
Debarment and Suspension Certification
(1) The prospective primary vendor certifies to the best of its knowledge and belief that it and its principals:
(a) Are not presently debarred, suspended, proposed for disbarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency;
(b) Have not within a three-year period preceding this application been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;
(c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this certification; and
(d) Have not within a three-year period preceding this application had one or more public transactions (Federal, State, or local) terminated for cause or default.
(2) Where the prospective primary vendor is unable to certify to any of the statements in this certification, such prospective primary vendor shall attach an explanation to this bid.
AUTHORIZED AGENT • PLEASE PRINT
VENDOR
NAME TITLE
SIGNATURE
DATE
mailto:sapurch@cosatx.us
Debarment and Suspension Certification
File details come from the government source that posted it. Updated .