3-Certification of Debarment.pdf
PDF 129 KB Posted
- Solicitation number
- RFP 27-04
- Issued by
- Upton County, Texas
About this file
This is a Certification of Debarment form required by the U.S. Department of Agriculture for lower tier covered transactions under Executive Order 12549 and 7 CFR Part 3017. The certification applies to a Science Discount Catalog RFP in Texas and requires prospective bidders to certify that neither they nor their principals have been debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from federal participation. Bidders must select one of two certification options: either certify compliance with the debarment requirements or attach an explanation if unable to certify. The form requires completion by an authorized representative with signature and date.
Bidders who submit a proposal implicitly certify their non-debarred status as of the signature date. Any bidder that discovers its certification was erroneous at submission or becomes erroneous due to changed circumstances must provide immediate written notice to the contracting entity. The regulations implementing this certification were published in the Federal Register on January 30, 1989, and both federal and state penalties exist for vendors and districts that knowingly enter into contracts with suspended or debarred persons. This certification is a mandatory compliance requirement for participation in the Science Discount Catalog procurement.
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Other files
| File | Type | Posted |
|---|---|---|
| 6-RFP 27-04 Science Discount Catalog.pdf | ||
| 4-Conflict of Interest.pdf | ||
| 2-Certification Regarding Lobbying.pdf | ||
| 7-SFDRCISD Vendor Form REV.pdf | ||
| 5-w-9.pdf | ||
| 8-Form 1295.pdf | ||
| 1-Declaration of Compliance.pdf |
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Text version
Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion Lower Tier Covered Transactions
U.S Department of Agriculture
This certification is required by the regulations implementing Executive Order 12549, Debarment and Suspension, 7 CFR Part 3017, Section 3017.510, Participants' responsibilities. The regulations were published as Part IV of the January 30, 1989, Federal Register (pages 4722- 4733). Copies of the regulations may be obtained by contacting the Department of Agriculture agency with which this transaction originated.
(Before completing certification, read the instructions below.)
Please check one choice below:
D The prospective lower tier participant certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency.
D When the prospective lower tier participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal.
Organization Name
Name and Title of Authorized Representative
Signature Date
Instructions For Suspension/Debarment Certification Statement
1. By signing and dating the certification statement, the bidder certifies that neither it nor any of its principals (e.g., key employees) has been proposed for debarment, debarred or suspended by a federal agency on the date signed.
2. The prospective bidder shall provide immediate written notice to the person to which this proposal is submitted if at any time the prospective bidder learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.
3. Federal and State penalties exist for vendors and districts that knowingly enter into contracts with suspended/debarred persons.
| Organization Name: |
| Name and Title of Authorized Representative: |
| Date: |
| Check Box9: Off |
| Check Box10: Off |
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