11-Debarment-Suspension Certification.pdf
PDF 881 KB Posted
- Solicitation number
- 26/0028
- Issued by
- Harris County, Texas
About this file
This is a vendor certification form issued by the Harris County Juvenile Probation Department in Texas for use in the RFP for an Educational Advocacy, Technical Support and Legal Assistance Program. The certification document requires vendors to affirm their eligibility to participate in the contract opportunity by confirming they are not debarred, suspended, proposed for debarment, or declared ineligible by any federal department or agency. Vendors must also certify that neither they nor their principals have been convicted of fraud or criminal offenses related to public transactions within the three-year period preceding the application, have not violated federal or state antitrust statutes, and have not been indicted or criminally or civilly charged for enumerated offenses.
The form requires vendors to select either "I certify" or "I am unable to certify" and provide their signature, printed name, and date. If a vendor is unable to certify the required statements, they must provide a written explanation for their inability to do so. This certification is a standard eligibility requirement for participation in the Harris County Juvenile Probation Department's procurement process and must be completed as part of the vendor's proposal submission.
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Text version
rev. 8/2021
HARRIS COUNTY JUVENILE PROBATION DEPARTMENT
VENDOR CERTIFICATION
Vendor certifies that it and its principals (as defined in 2 CFR Part 180.995):
Are not presently debarred, suspended, proposed for debarment, declared ineligible, sentenced to a denial of Federal benefits by a State or Federal Court, or voluntarily excluded from participation in this transaction by any federal department or agency;
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; or
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 the above bullet; and 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.
Select the appropriate response, provide requested information, and sign:
I certify.
I am unable to certify.
If you selected “I am unable to certify”, please provide an explanation as to why the applicant agency cannot certify the statements.
Explanation:________________________________________________________
Vendor Name Representative's Signature
Date
File details come from the government source that posted it. Updated .