12-Federal Tax Liability and Recent Felony Convictions Certification Fillable.pdf
PDF 218 KB Posted
- Attached to
- Facility Security Equipment Upgrade
- Solicitation number
- FY26-RFP-004
- Issued by
- Illinois
About this file
This document is a Federal Tax Liability and Recent Felony Convictions Certification form from Connect Transit, located in Normal, Illinois. The form requires third-party participants in agreements to certify two key compliance points: (1) they do not have any unpaid federal tax liability that has been assessed and exhausted of administrative remedies, and (2) they have not been convicted of a felony criminal violation under any Federal law within the preceding 24 months.
The document outlines specific requirements for potential third-party business associations, including corporations, partnerships, trusts, and other business entities. If a prospective participant cannot certify compliance, the recipient (Connect Transit) agrees to refer the matter to the Federal Transit Administration (FTA) and will not enter into any agreement without FTA's written approval. The form provides two certification options: a Certificate of Compliance (affirming adherence to requirements) and a Certification of Non-Compliance (indicating potential qualification for an exemption), with a warning that failure to obtain FTA waiver will result in the proposal being deemed non-compliant.
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Text version
FEDERAL TAX LIABILITY AND
RECENT FELONY CONVICTIONS CERTIFICATION
CERTIFICATE OF COMPLIANCE WITH FTA REQUIREMENTS
(please only check one (1) of the following certifications)
The Recipient agrees that, prior to entering into any Third-Party Agreement with any private corporation, partnership, trust, joint-stock company, sole proprietorship, or other business association, the Recipient will obtain from the prospective Third Party Participant a certification that the Third-Party Participant:
a. Does not have any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability; and
b. Was not convicted of the felony criminal violation under any Federal law within the preceding 24 months.
If the prospective Third-Party Participant cannot certify it, the Recipient agrees to refer the matter to FTA and not to enter into any Third-Party agreement with the Third-Party Participant without FTA’s written approval.
The Recipient agrees to require all Third-Party Participants to flow this requirement down to participants at all lower tiers, without regard to the value of any sub agreement.
Certificate of Compliance ☐ THE UNDERSINGED SOLEMNLY DECARES AND AFFIRMS UNDER PENALTY OF PERJURY THAT IT WILL
COMPLY WITH THE REQUREMENTS OF THE REGULTIONS CONTAINED HEREIN.
Certification of Non-Compliance
☐ THE UNDERSINGED HEREBY CERTIFIES THAT IT CANNOT COMPLY WITH THE REQUIREMENTS
CONTAINED HEREIN, BUT MAY QUALIFY FOR AN EXEMPTION CONSISTENT WITH 49 U.S.C. 5323(j)(2)(C).
SHOULD THE FEDERAL TRANSIT ADMINISTRATION (FTA) NOT GRANT A WAIVER, THE PROPOSAL WILL BE
DEEMED NON-COMPLIANT.
AUTHORIZED OFFICIAL: _______________________________________________
TITLE: _______________________________________________
FIRM NAME: _______________________________________________
SIGNATURE: _______________________________________________
DATE: _______________________________________________
| AUTHORIZED OFFICIAL: |
| TITLE: |
| FIRM NAME: |
| DATE: |
| Check: Off |
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