20-25-26-02-20 CERTIFICATION OF NON-DEBARMENT OR SUSPENSION.pdf
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- Attached to
- HODGE ELEMENTARY REFRIGERATOR
- Solicitation number
- 25-26-02-20
- Issued by
- Los Angeles County, Anaheim City, California
About this file
This is a Certification of Non-Debarment or Suspension form required by the Azusa Unified School District in California for a walk-in refrigerator procurement at Victor Hodge Elementary School located at 700 W. 11th Street, Azusa, CA 91702. The certification document establishes compliance requirements for all bidders and their associated personnel, including owners, partners, directors, officers, and managers.
The certification requires that all persons and firms certify under penalty of perjury that they are not currently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency. Bidders must further certify that within the three-year period preceding certification, they have not been convicted of or had a civil judgment rendered against them for fraud, criminal offenses related to public transactions, antitrust violations, embezzlement, theft, forgery, bribery, falsification or destruction of records, false statements, or receiving stolen property. Bidders must confirm they are not presently indicted or criminally or civilly charged with any of these offenses, have not had public transactions terminated for cause or default within three years, and will not subcontract with parties on the General Services Administration's List of Parties Excluded from Federal Procurement or Non-procurement Programs. The certifying official must provide signature, title, organization, and date, and must promptly notify Azusa Unified School District of any information that later contradicts the certification statements.
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Text version
CERTIFICATION OF NON-DEBARMENT OR SUSPENSION
In accordance with Executive Order 12549 and Executive Order 12689, entitled Debarment and Suspension, and any applicable implementing regulations, this certification must be completed by the Organization:
1. Under penalty of perjury, except as noted below, all persons or firms or any person associated therewith in the capacity of owner, partner, director, officer, or manager:
a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or agency.
b. Have not, within the three (3) year period preceding this certification, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction, 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. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses listed in subparagraph (1)(b) of this certification; and
d. Have not, within the three (3) year period preceding this certification, had one or more public transactions (Federal, state, or local) terminated for cause or default.
e. Will not subcontract with parties listed on the General Services Administration’s List of Parties Excluded from Federal Procurement or Non-procurement Programs
2. If such persons or firms later become aware of any information contradicting the statements of paragraph (1), they will promptly provide that information to Azusa Unified School District.
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL TITLE
ORGANIZATION DATE SIGNED
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