5-Debarment and Suspension Certification - Form.pdf
PDF 51 KB Posted
- Attached to
- Equipment Financing State and local contract opportunity
- Solicitation number
- FS-03-26
- Issued by
- Tyler County, Texas
About this file
This is a Debarment and Suspension Certification form issued by the City of San Angelo, Texas Purchasing Division for use in connection with the Equipment Financing contract opportunity. The certification requires prospective vendors to affirm that they and their principals are not currently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency. Vendors must also certify that within the three-year period preceding submission, they have not been convicted of or had a civil judgment rendered against them for fraud or criminal offenses related to public transactions, including violations of Federal or State antitrust statutes, embezzlement, theft, forgery, bribery, falsification or destruction of records, false statements, or receipt of stolen property.
The certification further requires vendors to confirm they are not presently indicted for or criminally or civilly charged with any of the enumerated offenses and that they have not had one or more public transactions terminated for cause or default within the three-year period preceding the application. Vendors unable to certify to any of the statements must attach a written explanation to their bid submission. The form requires completion and signature by an authorized agent of the prospective vendor, including the printed vendor name, title, signature, and date of execution.
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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 .