11-File S- Federal Debarment.pdf

This is a Federal Debarment Certification form applicable to the Beach Haven West Sanitary Sewer Replacement-Phase 8 project in New Jersey. The form requires certification of nondebarment status from the contracting entity and documentation of ownership structures for corporations, partnerships, and limited liability companies. Bidders must provide the name and physical address of the primary organization, identification of any stockholders, partners, or members owning more than 50 percent of voting interests, and information regarding parent entity ownership structures exceeding 50 percent. Additionally, contractors must disclose all controlled business entities and provide complete identification and contact information for each subsidiary or affiliated organization.

The form requires authorized representatives to provide full name, title, signature, and date on all certifications. Bidders must complete multiple sections addressing direct ownership, parent entity ownership, and contractor-controlled entities, with provisions to attach additional documentation as necessary. All signatories must certify under penalty of perjury that the provided information is accurate and that neither the organization nor any of its identified principals appear on federal debarment lists or suspension lists maintained by the General Services Administration or other federal agencies. This certification is a standard requirement for federal procurement compliance and must be completed and submitted as part of the bid package for this sanitary sewer replacement project.