14-CERTIFIED STATEMENT DEPARMENT.pdf

This document is a Certified Statement (Debarment) form for a business entity in Monroe County, Pennsylvania. The form requires the president or owner of a company to swear and attest that neither the company nor its leadership has ever been placed on a county, state, or federal debarment list as a result of work performed on public projects. The statement must be completed in the presence of a notary public, who will witness the signature, document the date, and note their commission expiration.

The form is a standard legal document used to verify a company's eligibility for public contracts by confirming they have not been prohibited from receiving government work due to past performance issues. It requires the company representative to provide their name, company name, and sign the document under oath, with the notary public completing the remaining certification details. This type of sworn statement is typically required as part of the bid or proposal submission process for government contracts to ensure contractor accountability and integrity.