2-Exhibit A - Debarment Certification Form.pdf
PDF 36 KB Posted
- Attached to
- Notice of Intent to Award Without Engaging in a Standard Procurement Process - Mathematics Materials
- Solicitation number
- AL27-009-SS
- Issued by
- Salt Lake County, Utah
About this file
This is a Debarment Certification Form associated with a Notice of Intent to Award Without Engaging in a Standard Procurement Process issued by Granite School District in Utah for mathematics materials procurement. The document serves as a certification requirement for vendors participating in this non-standard procurement process. The procurement pertains to mathematics materials, and any vendor wishing to challenge this notice of intent to award must submit documentation via email to Adar Livni at alivni@graniteschools.org prior to the event close date. Challenging vendors must provide their name, contact person, and detailed explanation of why they believe other qualified sources exist for the specified materials, along with documentation demonstrating their ability to provide comparable or superior products that meet or exceed the stated specifications.
Vendors submitting challenges must include evidence of their capability to provide either the same proprietary item or an equivalent product. If transitional costs are cited as justification for the non-standard procurement process, challenging vendors must provide a cost comparison analysis between the district's identified transitional costs and their anticipated transitional costs. The debarment certification form functions as a prerequisite compliance document ensuring that awarded vendors meet eligibility requirements and have no disqualifying debarment status. No pricing information, contract term details, or renewal options are specified in this particular form, as it serves solely as a certification and compliance verification mechanism within the broader procurement process.
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Text version
EXHIBIT “A”
DEBARMENT CERTIFICATION FORM
The Contractor certifies that, neither the Contractor firm nor any owner, partner, director, officer, or principal of the Contractor, nor any person in a position with management responsibility or responsibility for the administration of federal funds:
(a) Is presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by any federal or state department/agency;
(b) Has within a three-year period preceding this certification been convicted of or had a civil judgment rendered against it for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public transaction or contract (federal, state, or local); violation of federal or state antitrust statutes; or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;
(c) Is presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (b) above;
or
(d) Has within a three-year period preceding this certification had one or more public transactions or contracts (federal, state, or local) terminated for cause or default.
(e) The contractor is “Actively” registered with SAMS (Service for Award Management), and has been assigned the following DUNS Number: __________________________.
The Contractor further certifies that it shall not knowingly enter into any transaction with any subcontractor, material supplier, or vendor who is debarred, suspended, declared ineligible, or voluntarily excluded from covered transactions by any federal or state department/agency.
Dated this ___________________ day of _______________, 20 __________
By__________________________________________________________
Authorized Signature for Contractor
Printed Name and Title
File details come from the government source that posted it. Updated .