3-D-DFCM Termination or Debarment Certification Form, 5.8.25.docx

This is a Termination or Debarment Certification Form issued by the State of Utah Division of Facilities Construction and Management (DFCM) for use in conjunction with the construction of a new veterans memorial cemetery in Washington Terrace, Utah. The form is a standard compliance document required from contractors bidding on DFCM construction projects, specifically for the Northern Utah Veterans Cemetery project estimated at $12,000,000. The certification form must be completed and signed by an authorized representative of the contracting entity prior to award.

The form requires contractors to certify under signature that they are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from soliciting work by any government agency, and that they have not been terminated during contract performance or withdrawn from a contract to avoid termination. If a contractor cannot certify to these requirements, the form provides space for explanation of circumstances with supporting signatures and dates. This certification is a mandatory pre-award requirement ensuring contractor eligibility and compliance with government contracting regulations.