3-C-DFCM Termination Debarment Certification Form 8.9.2024.pdf

667 KB Posted

Attached to
DFCM Construction - VBS Code & Special Inspections Services - Nucleus Group-USHE - Convergence Hall - Project #24279300
Solicitation number
MP27005-INSPECTIONS
Issued by
Utah

About this file

Written by GovTribe AI ·

This is a Termination Debarment Certification Form submitted to the State of Utah's Division of Facilities Construction and Management (DFCM) for the Convergence Hall project, a Code & Special Inspections Services contract opportunity with an estimated inspections budget of $650,000.00. The form serves as a certification document required from contractors and service providers bidding on or participating in DFCM projects. The Convergence Hall project involves a 163,000 square-foot, six-story building at the University of Utah featuring office, maker space, retail, event, and housing components, requiring comprehensive code and special inspection services throughout the construction process.

All special inspections contractors, material testing labs, and special inspectors working on this DFCM project must be listed on the DFCM Approved Special Inspection Firms, Material Testing Labs, & Special Inspectors list, whether working independently or for a DFCM Prequalified Code Inspection Firm. The termination and debarment certification form documents the contractor's attestation regarding their eligibility and compliance status, confirming they have not been terminated for default or debarred from federal or state contracts, which is a standard requirement for participation in state construction and professional services contracts.

View the file

Other files

File Type Posted
8-6-MP27005-24279300 CoHa DD 100 Narrative.pdf PDF
6-1-MP27005-24279300 Solicitation.pdf PDF
7-3-MP27005-24279300 CoHa Draft Early Bid Package Schedule All Activities.pdf PDF
5-2-MP27005-24279300 CoHa Draft Early Bid Package Schedule Summary.pdf PDF
1-B-DFCM Performance References Form 2.5.25.docx DOCX document
10-5-MP27005-24279300 CoHa DD 100 Drawings.pdf PDF
9-4-MP27005-24279300 CoHa DD 100 Specifications.pdf PDF
4-D-DFCM Health Insurance Statement of Compliance Form, Revised 7.28.25.docx DOCX document
2-A-DFCM General Conditions August 2020-Clean rev 07122023.pdf PDF

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file
Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

DFCM Termination or Debarment Certification Form, Revised 8.9.2024

Termination or Debarment Certification Form

Firm Name:

State of Utah Department of Public Licensing Number, if applicable:

The signature below certifies that the referenced firm nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or are voluntarily excluded from soliciting work by any government agency. This form also certifies that neither they nor their principals have been terminated during the performance of a contract or withdrew from a contract to avoid termination.

Signature:

Name:

Title:

Date:

If the firm cannot certify to the statement above, please provide an explanation of the circumstances below.

Signature:

Name:

Title:

Date:

Firm Name:
0:
Name:
0:
1:
Title:
0:
1:
Date:
0:
1:
DOPL:
Signature2:

Explanation:

File details come from the government source that posted it. Updated .