3-G. Debar Cert.pdf
PDF 231 KB Posted
- Attached to
- Traffic Signal Loop Installation
- Solicitation number
- 269-2026-209
- Issued by
- Mecklenburg County, Charlotte City, North Carolina
About this file
This is a Debarment Certification form for Project 269.2026.209 related to a Traffic Signal Loop Installation contract opportunity in North Carolina. The certification requires the bidder, contractor, or subcontractor to attest that neither they nor their principals—including officers, directors, managers working on the contract, or persons holding greater than 10% equity interest—are currently debarred, suspended, proposed for debarment, or voluntarily excluded from covered transactions by any federal or state department or agency. The form mandates disclosure of any convictions or civil judgments within the three-year period preceding the proposal related to fraud, criminal offenses in connection with public transactions, violations of federal or state antitrust or procurement statutes, or crimes including embezzlement, theft, forgery, bribery, falsification of records, false statements, or receipt of stolen property.
The certification further requires disclosure of any current indictments or criminal or civil charges by any government entity for offenses enumerated in the certification, as well as any public transactions terminated for cause or default within the three-year period preceding the application. The form includes a signature section for authorized representatives and provides a checkbox option for bidders unable to certify to one or more statements, with space to attach an explanation. False statements on this certification may result in proposal rejection, termination of the award, or criminal prosecution.
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Other files
| File | Type | Posted |
|---|---|---|
| 4-I. CBI Form 3.pdf | ||
| 9-J. Contract Exceptions.pdf | ||
| 10-B. RFP 269.2026.209.pdf | ||
| 5-D. Proposal Submission Form.pdf | ||
| 6-E. References Form.pdf | ||
| 7-C. Sample Services Contract 2025.pdf | ||
| 8-H. Anti Lobby Cert.pdf | ||
| 2-F. Price Schedule.xlsx | XLSX spreadsheet | |
| 1-A. Bonfire, EUNA Guide.pdf |
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Text version
CERTIFICATION REGARDING DEBARMENT, SUSPENSION,
AND OTHER RESPONSIBILITY MATTERS
Project 269.2026.209
The bidder, contractor, or subcontractor, as appropriate, certifies to the best of its knowledge and belief that neither it nor any of its officers, directors, or managers who will be working under the Contract, or persons or entities holding a greater than (ten percent) 10% equity interest in it (collectively “Principals”):
1. Are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal or state department or agency in the United States;
2. Have within a three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state anti-trust or procurement statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;
3. Are presently indicted for or otherwise criminally or civilly charged by a government entity, (federal, state or local) with commission of any of the offenses enumerated in paragraph 2 of this certification; and
4. Have within a three-year period preceding this application/proposal had one or more public transactions (federal, state or local) terminated for cause or default.
I understand that a false statement on this certification may be grounds for rejection of this proposal or termination of the award or in some instances, criminal prosecution.
I hereby certify as stated above:
(Print Name) Signature
Title Date
I am unable to certify to one or more the above statements. Attached is my explanation. [Check box if applicable]
(Print Name) Signature
File details come from the government source that posted it. Updated .