5-5 - Appendix B - Debarment and Licensing Certificate.docx
DOCX document 32 KB Posted
- Attached to
- 26RFSQ13 Regional Water Plan
- Solicitation number
- 26RFSQ13
- Issued by
- Williamson County, Texas
About this file
This is a Debarment and Licensing Certificate for the State of Texas, County of Williamson, required as part of the qualification submission for engineering firms seeking to provide services on the 26RFSQ13 Regional Water Plan project. The certificate serves as a sworn certification by the respondent/bidder and its principals, confirming eligibility to participate in the contract opportunity. Respondents must certify that they and their principals are not currently debarred, suspended, proposed for debarment, or excluded from federal covered transactions; have not been convicted of or had civil judgments rendered against them for fraud, criminal offenses, antitrust violations, embezzlement, theft, forgery, bribery, falsification of records, false statements, or receiving stolen property within three years preceding the proposal; are not presently indicted or criminally or civilly charged with any enumerated offenses; have not had public transactions terminated for cause or default within three years; and have not been disciplined or issued formal reprimands by any state agency for professional accreditation within three years.
The certificate requires the signature, printed name, and title of the certifying representative and must be notarized by a Texas notary public, including the notary's commission expiration date. Any certifying representative unable to affirm to the statements in the certification must attach a written explanation to the document. This debarment certification is a standard requirement for public contracting in Texas and ensures that only qualified, eligible firms with no disqualifying legal or disciplinary history participate in the procurement process for Williamson County's regional water planning services.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 7-7 - Appendix D - Anti-Boycott Statement.pdf | ||
| 4-4 - RFQ Design Engineering Contract Template.docx | DOCX document | |
| 1-1 - 26RFSQ13 Regional Water Plan Scope of Services.docx | DOCX document | |
| 2-2 - RFSQ General Information.docx | DOCX document | |
| 8-TEAMS link for virtual closing 26RFSQ13 Regional Water Plan.docx | DOCX document | |
| 3-3 - RFQ Evaluation Selection Criteria.docx | DOCX document | |
| 6-6 - Appendix C - Conflict of Interest Questionnaire.docx | DOCX document |
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Text version
Debarment and Licensing
| STATE OF TEXAS | § | ||
| § | |||
| COUNTY OF WILLIAMSON | § |
I, the undersigned, being duly sworn or under penalty of perjury under the laws of the United States and the State of Texas, certify, on behalf of Respondent/Bidder and its principals, that Respondent/Bidder and its principals:
a. Are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from covered transactions by any federal department or agency:
b. 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* 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* with commission of any of the offenses enumerated in Paragraph (b) of this certification;
d. Have not, within a three-year period preceding this application/proposal, had one or more public transactions* terminated for cause or default; and
e. Have not been disciplined or issued a formal reprimand by any State agency for professional accreditation within the past three years.
NOTE: Where the certifying representative is unable to certify to any of the statements in this certification, such individual shall attach an explanation to this certification.
* federal, state, or local
Signature of Certifying Representative
Printed Name of Certifying Representative
Title of Certifying Representative
Date
SUBSCRIBED and sworn to before me, the undersigned authority, by
| Signatory Name | |||
| the | of | , on behalf of said firm. | |
| Signatory Title | Entity Name |
Notary Public in and for the State of Texas My commission expires:
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