3-4-DFCM Termination or Debarment Certification Form, 7.15.26.docx

This is a Termination or Debarment Certification Form for the State of Utah's Division of Facilities Construction and Management (DFCM) related to a contractor prequalification opportunity for public school construction. The form requires contractors to certify that they are not currently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from soliciting work by any government agency. Additionally, contractors must certify that they have not been terminated during contract performance or withdrawn from a contract to avoid termination. The form includes fields for contractor name, signature, signer's name and title, date, and space for explanation of circumstances if the contractor cannot certify to the above statement. This certification is a mandatory compliance document required as part of the DFCM's Statements of Qualifications (SOQ) process for electrical, general, fire protection systems, HVAC/mechanical, plumbing, and roofing contractors seeking prequalification for participation in public school construction competitive procurements.

No pricing terms, funding amounts, or other financial information is contained within this certification form. The form serves exclusively as a compliance verification document to ensure contractor eligibility and integrity. Contractors unable to provide the required certification must provide detailed explanations of any debarment, suspension, termination, or exclusion actions. Submission of this form is required for all contractors participating in the prequalification process, which includes a mandatory meeting scheduled for Wednesday, August 26th at 1:00 PM.