4-Debarment and Suspension Certification - Form.pdf

PDF 51 KB Posted

Attached to
Fleet Vehicles State and local contract opportunity
Solicitation number
FS-02-25
Issued by
Tyler County, Savannah CDP, Texas

About this file

The document is a Debarment and Suspension Certification form issued by the City of San Angelo, Texas Purchasing Division. This standard certification requires prospective primary vendors to affirm their legal and ethical standing when bidding on city contracts. The certification mandates that vendors declare they are not currently debarred, suspended, or excluded from federal transactions, and have not been convicted of fraud, criminal offenses, or other specified legal violations within the past three years.

The certification requires vendors to confirm they are not currently indicted or criminally charged by any governmental entity for specified offenses, and have not had public transactions terminated for cause or default. If a vendor cannot certify to any of these statements, they are required to attach a detailed explanation to their bid. The form provides space for a vendor's authorized agent to print their name, title, and provide a signature and date, serving as an official attestation of the vendor's compliance with these contractual integrity requirements.

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Text version

CITY OF SAN ANGELO, TEXAS

PURCHASING DIVISION

72 West College Avenue, San Angelo, Texas 76903

325.657.4219 • sapurch@cosatx.us

CITY OF SAN ANGELO, TEXAS • DEBARMENT AND SUSPENSION CERTIFICATION

Debarment and Suspension Certification

(1) The prospective primary vendor certifies to the best of its knowledge and belief that it and its principals:

(a) Are not presently debarred, suspended, proposed for disbarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency;

(b) Have not within a three-year period preceding this application 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 antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;

(c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this certification; and

(d) Have not within a three-year period preceding this application had one or more public transactions (Federal, State, or local) terminated for cause or default.

(2) Where the prospective primary vendor is unable to certify to any of the statements in this certification, such prospective primary vendor shall attach an explanation to this bid.

AUTHORIZED AGENT • PLEASE PRINT

VENDOR

NAME TITLE

SIGNATURE

DATE

mailto:sapurch@cosatx.us

Debarment and Suspension Certification

File details come from the government source that posted it. Updated .