4-Form Certification-of-Financial-Condition 09.2021 (2).pdf
PDF 142 KB Posted
- Attached to
- Truist Stadium Paint project
- Solicitation number
- 59-Q6897
- Issued by
- Guilford County, North Carolina
About this file
This document is a North Carolina Certification of Financial Condition form dated September 2021, designed for vendors participating in a state solicitation process. The form requires vendors to self-certify their financial status by checking several boxes affirming their sound financial condition, including having an unqualified audit, no outstanding liabilities, current tax payments, no ongoing litigation, and authorization to make these statements.
The certification serves as a mandatory compliance document for potential state contractors, with vendors required to disclose any exceptions or reasons for not meeting the standard criteria. Failure to fully complete the form or explain any unchecked boxes may result in the vendor being deemed non-responsive and having their submission rejected. The document includes a continuing certification requirement, mandating that vendors notify the contract lead within 30 days of any material changes to the representations made in the form.
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Text version
North Carolina Certification of Financial Condition Version Date: 09/2021
Page | 1
ATTACHMENT G: CERTIFICATION OF FINANCIAL CONDITION
Solicitation #: __________________________
Vendor Name: __________________________
The undersigned hereby certifies that: [check all applicable boxes]
☐ The Vendor is in sound financial condition and, if applicable, has received an unqualified audit opinion for the latest audit of its financial statements.
Date of latest audit: ____________________ (If no audit within past 18 months, explain reason below.)
☐ The Vendor has no outstanding liabilities, including tax and judgment liens, to the Internal Revenue Service or any other government entity.
☐ The Vendor is current in all amounts due for payments of federal and state taxes and required employment-related contributions and withholdings.
☐ The Vendor is not the subject of any current litigation or findings of noncompliance under federal or state law.
☐ The Vendor has not been the subject of any past or current litigation, findings in any past litigation, or findings of noncompliance under federal or state law that may impact in any way its ability to fulfill the requirements of this Contract.
☐ He or she is authorized to make the foregoing statements on behalf of the Vendor.
Note: This shall constitute a continuing certification and Vendor shall notify the Contract Lead within 30 days of any material change to any of the representations made herein.
If any one or more of the foregoing boxes is NOT checked, Vendor shall explain the reason(s) in the space below. Failure to include an explanation may result in Vendor being deemed non-responsive and its submission rejected in its entirety.
Signature Date
Printed Name Title
[This Certification must be signed by an individual authorized to speak for the Vendor]
ATTACHMENT G: CERTIFICATION OF FINANCIAL CONDITION
| Solicitation: |
| Vendor Name: |
| The Vendor is in sound financial condition and if applicable has received an unqualified audit: Off |
| The Vendor has no outstanding liabilities including tax and judgment liens to the Internal Revenue: Off |
| The Vendor is current in all amounts due for payments of federal and state taxes and required: Off |
| The Vendor is not the subject of any current litigation or findings of noncompliance under federal or: Off |
| The Vendor has not been the subject of any past or current litigation findings in any past litigation: Off |
| He or she is authorized to make the foregoing statements on behalf of the Vendor: Off |
| If no audit within past 18 months explain reason: |
| 1: |
| Date: |
| Printed Name: |
| Title: |
File details come from the government source that posted it. Updated .