3-Attachment 9. Certification re Debarment Suspension.pdf
PDF 101 KB Posted
- Solicitation number
- RFQ-2025-004
- Issued by
- Milwaukee County, Mattoon Village, Wisconsin
About this file
This document is a Certification Regarding Debarment and Suspension form, designed for an applicant to certify their legal and ethical standing when pursuing a public transaction or contract. The certification requires the applicant to confirm that its principals, owners, officers, shareholders, key employees, directors, and member partners: (1) are not currently debarred or suspended from federal transactions; (2) have not been convicted of fraud or criminal offenses in public transactions within the past three years; (3) are not currently indicted for criminal charges; and (4) have not had public transactions terminated for cause or default within the past three years.
The form serves as a legal declaration of the applicant's good standing and integrity in business dealings, specifically focusing on preventing organizations with past legal or ethical violations from participating in public contracts. By signing this document, the applicant attests under penalty of potential legal consequences that they meet the specified clean business conduct standards across federal, state, and local levels. The form provides blank spaces for an authorized signature, printed name, title, and company information to formalize the certification.
View the file
Other files
Show all 12
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
ATTACHMENT 9
CERTIFICATION REGARDING
DEBARMENT AND SUSPENSION
The applicant certifies to the best of its knowledge and belief that its principals, owners, officers, shareholders, key employees, directors and member partners: (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 the date of 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 charged by a governmental entity
(Federal, State or local) with commission of any of the offenses enumerated in (2) of this certification; and (4) have not within a three-year period preceding the date of this proposal had one or more public transactions (Federal, State or local) terminated for cause or default.
Authorized Signature: Date:
Printed Name: Title:
Company:
File details come from the government source that posted it. Updated .