47_017 _ Exhibit H _ Debarment and Suspension.pdf
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- Solicitation number
- PE-77129-NONST-2027-000000078
- Issued by
- Hall County, Georgia
About this file
This is a Debarment and Suspension Certification Form required by Hall County Government's Financial Services Purchasing Division for the Hall County Jail Roof Replacement (Towers) project in Gainesville, Georgia. All bidders must complete and submit this certification form with their bid to demonstrate their eligibility to participate in the contract opportunity.
The certification requires bidders to attest under penalty of perjury that they and their principals are not currently debarred, suspended, proposed for debarment, or declared ineligible by any Federal department or agency; have not been convicted of or had civil judgments rendered against them for fraud or criminal offenses related to public transactions within the three-year period preceding the proposal; are not presently indicted or criminally or civilly charged by any governmental entity for any enumerated offenses; and have not had one or more public transactions terminated for cause or default within the three-year period preceding the application. Bidders unable to certify any of these statements must attach a written explanation to their proposal. The form requires completion of company name, authorized signature, printed name and title of the signatory, and the date of certification.
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Text version
Hall County Government
FINANCIAL SERVICES
PURCHASING DIVISION
POST OFFICE DRAWER 1435
GAINESVILLE, GA 30503
t: 770.535.8270 | f: 770.531.6711
FINANCIAL SERVICES DIRECTOR
Taylor Samples, CPA
ASSISTANT FINANCE DIRECTOR
Elizabeth White
PURCHASING MANAGER
Andrew Youngblood
EXHIBIT H – DEBARMENT AND
SUSPENSION CERTIFICATION FORM
Bidders must complete and return this form with their bid.
The undersigned Respondent certifies, to the best of his or her knowledge and belief, that it and its principals (as defined 2 CFR
200.214 and 2 CFR 180.300):
1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency;
2. Have not 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;
3. 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 this certification; and
4. Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State or local) terminated for cause or default.
Where the Respondent is unable to certify any of the statements in this certification, such Respondent shall attach an explanation to this proposal.
Company Name: ______________________________________
Authorized Signature: _________________________________
Printed Name & Title: __________________________________
Date: ________________________________________________
File details come from the government source that posted it. Updated .