4-4-DFCM Termination or Debarment Certification Form, 7.15.26.docx

This is a Termination or Debarment Certification Form required by the State of Utah's Division of Facilities Construction and Management (DFCM) for contractors seeking prequalification to perform work on public school construction projects. The form serves as a prerequisite certification document for code inspectors and plan reviewers who wish to be prequalified for DFCM construction projects. Contractors must certify that they are not currently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from soliciting work by any government agency. Additionally, contractors must certify that they have not been terminated during the performance of a contract or withdrawn from a contract to avoid termination. A mandatory meeting for all code inspectors and plan reviewers seeking prequalification is scheduled for Wednesday, August 26th, 2026 at 1:00 PM, with attendance required either in person or virtually.

If a contractor cannot certify the statements outlined above, they are required to provide a detailed written explanation of the circumstances. DFCM will review any disclosed circumstances to determine whether the contractor will be considered for prequalification. The form requires the contractor's name, signature, signer's name, and date of certification. Contractors unable to provide a clean certification must complete the additional explanation section with their signature, name, and date for DFCM's evaluation and consideration.