3-Certification of Non-Debarment Rev 09.24.2024.pdf
PDF 142 KB Posted
- Attached to
- Air Handler Unit 2 & 4 Restoration Project
- Solicitation number
- 25-06923
- Issued by
- California
About this file
This is a Certification of Non-Debarment form required by Inland Empire Health Plan (IEHP), a local public entity of the State of California, for participation in the Air Handler Unit 2 & 4 Restoration Project bid process. The certification serves as an attestation by an authorized representative that the bidding firm, company, or sole proprietorship is not excluded, ineligible, or terminated from participation in State or Federal health care programs. Bidders must verify their firm's status against four specific exclusion lists: the Department of Health & Human Services Office of Inspector General List of Excluded Individuals and Entities (LEIE), the General Services Administration System for Award Management (SAM.gov), the California Department of Health Care Services Medi-Cal Suspended and Ineligible Provider List (S&I List), and the Medicare Opt-Out List. The certification further requires that if selected for contract award, the bidder will conduct regulatory sanction and exclusion screenings of all subcontracted entities prior to engagement and continue such screenings on a monthly basis throughout the contract period.
The form establishes that any contractor that becomes excluded, ineligible, or terminated from participation in State and Federal health care programs will have their contract with IEHP immediately terminated for cause. The document requires the authorized representative's signature, date, and title, with execution constituting certification that the signatory has read and understands all terms and conditions and that the principal is fully bound and committed to compliance. This certification is a standard prerequisite requirement for bid submission and does not address pricing, set-asides, or other commercial terms related to the Air Handler Unit restoration project.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 1-IEHP-iRFB-25-06923 AHU Restoration Posted 2-20-26.pdf | ||
| 2-iRFB Bid Forms.pdf |
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Text version
Certification of Non-Debarment Rev_09.24.2024
CERTIFICATION
As an authorized representative of my Firm/Company/Sole Proprietorship, I hereby attest that my Firm/Company/Sole Proprietorship is not excluded, ineligible, or terminated from participation in State or Federal health care programs and does not appear on any of the following lists:
a. The Department of Health & Human Services (DHHS), Office of Inspector General (OIG), and List of Excluded Individuals and Entities (LEIE). Please visit https://exclusions.oig.hhs.gov.
b. General Services Administration (GSA), and the System for Award Management (SAM.gov). Please visit https://www.sam.gov.
c. California Department of Health Care Services (DHCS), and Medi-Cal Suspended and Ineligible Provider List (S&I List). Please visit https://mcweb.apps.prd.cammis.medi-cal.ca.gov/references/sandi.
d. Medicare Opt-Out List. Please visit https://data.cms.gov/tools/provider-opt-out-affidavits-look-up-tool.
I further attest that if selected, my Firm/Company/Sole Proprietorship will conduct regulatory sanction and exclusion screenings of subcontracted entities prior to engagement with said entities and monthly thereafter.
I understand that if my Firm/Company/Sole Proprietorship becomes excluded, ineligible, or terminated from participation in State and Federal health care programs, any contracts held with IEHP will be subject to immediate termination for cause.
RFP Name/Number:
Signature: Date:
Title of Agent/Officer:
"Execution hereof is certification that the undersigned has read and understands the terms and conditions hereof, and that the undersigned's principal is fully bound and committed."
https://exclusions.oig.hhs.gov/ https://www.sam.gov/ https://mcweb.apps.prd.cammis.medi-cal.ca.gov/references/sandi https://data.cms.gov/tools/provider-opt-out-affidavits-look-up-tool https://data.cms.gov/tools/provider-opt-out-affidavits-look-up-tool
File details come from the government source that posted it. Updated .