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

This is a Termination or Debarment Certification Form required by the State of Utah Division of Facilities Construction and Management (DFCM) for the Weber State University Student Services Building MEP Phase II construction project. The form certifies that the contractor submitting the proposal is not currently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from soliciting work by any government agency. The certification also confirms that the contractor has not been terminated during the performance of a prior contract or withdrawn from a contract to avoid termination. Contractors must complete the form by providing their company name, authorized signatory information including name and title, and the date of certification.

If a contractor cannot certify compliance with the stated requirements, the form provides a space for the contractor to explain the circumstances surrounding any debarment, suspension, termination, or exclusion history. This explanation section requires the same signatory information as the certification section. The form serves as a mandatory compliance document for the construction services solicitation related to the selective remodeling and MEP upgrade to a hybrid VRF system at Weber State University, with an estimated construction cost of $5,400,000.00.