2-B-DA26039 DFCM Termination or Debarment Certification Form 5.8.25.docx

This is a Termination or Debarment Certification Form prepared by the State of Utah Division of Facilities Construction and Management (DFCM) for use in connection with its FY2027 Code Inspection Firm Prequalification solicitation. The form certifies that the contractor submitting it is not currently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from soliciting work by any government agency. The certification also confirms that the contractor has not been terminated during the performance of a previous contract or withdrawn from a contract to avoid termination. The form requires the contractor's name, signature, and date, along with the signatory's name and title. If the contractor cannot certify to these standards, the form provides space for an explanation of circumstances.

This certification form is a standard prerequisite document for the open-ended Stage I Request for Statement of Qualifications issued by DFCM to prequalify code inspection firms to perform code and special inspection services for statewide capital projects throughout Utah. Firms selected through this prequalification process will be prequalified for an 18-month period beginning July 1, 2026 and expiring December 31, 2027. Prior to the expiration of each 18-month prequalification period, all prequalified firms must submit renewal documents to maintain their prequalified status for the subsequent 18-month term.