3-07 - Suspension and Debarment Certification.pdf
PDF 72 KB Posted
- Solicitation number
- RFQ 26-19404-TF
- Issued by
- Henderson County, Texas
About this file
This is a Suspension and Debarment Certification form required by the City of Lubbock, Texas for on-call consulting services at Lubbock Preston Smith International Airport. The certification applies to procurement contracts and sub-awards equal to or exceeding $25,000 and serves to verify compliance with Federal Law (A-102 Common Rule and OMB Circular A-110). The form requires the authorized company official to certify under signature that neither the firm nor its principals are suspended or debarred by any Federal agency prior to award of contracts valued at $25,000 or more.
The form provides spaces for the company name, Federal Tax ID number, signature of the company official, printed name of the signatory, and date signed. Multiple signature blocks are included to accommodate different signatories or entities as needed. Contractors must complete and submit this certification as a condition of contract eligibility and award.
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SUSPENSION AND DEBARMENT CERTIFICATION
Federal Law (A-102 Common Rule and OMB Circular A-110) prohibits non-Federal entities from contracting with or making sub-awards under covered transactions to parties that are suspended or debarred or whose principals are suspended or debarred. Covered transactions include procurement contracts for goods or services equal to or in excess of $25,000 and all non-procurement transactions (e.g., sub-awards to sub-recipients).
Contractors receiving individual awards of $25,000 or more and all sub-recipients must certify that their organization and its principals are not suspended or debarred by a Federal agency.
Before an award of $25,000 or more can be made to your firm, you must certify that your organization and its principals are not suspended or debarred by a Federal agency.
I, the undersigned agent for the firm named below, certify that neither the firm nor its principals are suspended or debarred by a Federal agency.
COMPANY NAME:
Firm’s Federal Tax ID Number: ______________________________________________
Signature of Company Official:
Printed name of company official signing above:
Date Signed:
| COMPANY NAME: |
| Firms Federal Tax ID Number: |
| Printed name of company official signing above: |
| Date Signed: |
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