11-Vendor Debarment Statement.pdf
PDF 77 KB Posted
- Attached to
- HVAC Equipment, Service and Supplies
- Solicitation number
- 1075HVAC
- Issued by
- Victoria County, Texas
About this file
This document is a Vendor Debarment Statement form for school districts in the State of Texas, requiring vendors to certify that they have not been debarred or suspended from conducting business with educational institutions. The form is required by regulations implementing Executive Order 12549, specifically the Debarment and Suspension guidelines outlined in 7 CFR Part 3017, Section 3017.510, which were published in the January 30, 1989 Federal Register.
The form provides space for a company to document its details, including name, mailing address, contact information, and a signature affirming compliance with debarment regulations. Vendors must confirm they are not prohibited from doing business with Texas school districts and can obtain copies of the full regulation by contacting the originating Department of Agriculture Agency. The document includes checkboxes to indicate any changes in contact information and requires the preparer to provide their title and sign the form, certifying the accuracy of their statement.
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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____
File details come from the government source that posted it. Updated .