4-F. CERTIFICATION REGARDING DEBARMENT.pdf
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- Attached to
- Site and Civil Engineering and Design
- Solicitation number
- 269-2026-143
- Issued by
- Mecklenburg County, Cleveland Town, North Carolina
About this file
This document is a Request for Qualifications (RFQ # 269.2026.143) for Site and Civil Engineering Design Services, featuring a Certification Regarding Debarment, Suspension, and Other Responsibility Matters. The certification form requires bidders, contractors, or subcontractors to affirm their legal and ethical standing by confirming they are not currently debarred, suspended, or ineligible for public transactions, and have not been convicted of fraud, criminal offenses, or had public contracts terminated within the past three years.
The document provides a standard compliance form where potential contractors must disclose any legal issues or challenges that might impact their eligibility to bid on or perform the engineering design services contract. By signing the document, the bidder attests to their good standing or indicates their inability to certify compliance, with the understanding that false statements could result in proposal rejection, contract termination, or potential criminal prosecution. The form includes spaces for printing names, signatures, titles, and dates, as well as an option to attach an explanation if the bidder cannot fully certify their compliance with the listed requirements.
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Text version
RFQ # 269.2026.143
SITE AND CIVIL ENGINEERING DESIGN SERVICES
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS
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
| RFQ # 269.2025.099 |
| Owner Advisor, Program Management Support and Augmentation, and Program/Project Controls and Risk Management Support |
| CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS |
File details come from the government source that posted it. Updated .