24-Certification of Primary Participant Form.pdf
PDF 112 KB Posted
- Solicitation number
- RFP-RC-2026-011
- Issued by
- Rockland County, New York
About this file
This is a Certification of Primary Participant Form required for submission with proposals to the County of Rockland, New York, for the Public Transit Management, Operations, and Maintenance Services contract for Transport of Rockland (TOR). The form serves as a certification regarding debarment, suspension, and other responsibility matters that must accompany all proposals submitted in response to this solicitation. The contract opportunity involves the selection of a qualified firm to operate the TOR public transit bus service, which includes management, administrative, technical, mechanical, and vehicle operator staffing for a fixed-route intra-county bus service. The TOR system currently operates a fleet of 45 vehicles owned by the County of Rockland that were purchased with funding from the Federal Transit Administration, New York State Department of Transportation, and local matching funds. The services required encompass daily management and oversight of the bus system, including maintenance and repairs, scheduling, routing, road supervision, safety and accident investigation, fare collection, Intelligent Transportation Systems (ITS) support, and customer service activities under both normal and emergency operating circumstances.
The certification form requires the primary participant and its principals to affirm under penalty of perjury that they are not debarred, suspended, or ineligible for Federal transactions; have not been convicted of fraud or criminal offenses related to public contracts within the preceding three years; are not currently indicted or charged with such offenses; and have not had public transactions terminated for cause or default within the preceding three years. Submission of this form is mandatory for all solicitations exceeding $10,000 and is particularly applicable to this contract opportunity, which exceeds the $100,000 threshold. Any participant unable to certify to the statements must attach an explanation to the certification. The form must be signed by an authorized official with the date of signature and title provided.
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Text version
THIS FORM MUST BE SUBMITTED WITH YOUR PROPOSAL
CERTIFICATION OF PRIMARY PARTICIPANT
Regarding Debarment, Suspension and Other Responsibility Matters
The certifies to the best of its knowledge (firm name/principal) and belief, that it and its principals:
1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency;
2. Have not within a three-year period preceding this proposal 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;
3. 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 enumerated in paragraph (2) of this certification; and
4. Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State or local) terminated for cause or default.
If unable to certify to any of the statements in this certification, the participant shall attach an explanation to this certification.
The primary participant, certifies or
(firm name/principal) affirms the truthfulness and accuracy of the contents of the statements submitted on or with this certification and understands that the provisions of 31 U.S.C. sections 3801 et seq. are applicable thereto.
Signature and Title of Authorized Official
Date
THIS FORM MUST BE SUBMITTED WITH YOUR PROPOSAL
| Solicitations Exceeding $10,000 |
| Solicitations Exceeding $25,000 |
| Awards Exceeding $100,000 |
File details come from the government source that posted it. Updated .