5-GSD - Exhibit A - Debarment Certification Form.pdf
PDF 36 KB Posted
- Solicitation number
- SF26-03
- Issued by
- Salt Lake County, Utah
About this file
This is a Debarment Certification Form associated with a Solid Phenolic Bathroom Partitions procurement for Olympus Jr High conducted by Granite School District in Utah. The form serves as a compliance document for this invitation for bid (IFB), which seeks solid phenolic bathroom partitions with hardware to be installed by the GSD Carpenter Shop. The procurement anticipates a single award to the lowest cost responsive and responsible vendor, with vendor pricing guaranteed for 90 days. Specifications and drawings are available in the bid public files section, and questions should be submitted through the designated Q&A section.
The Debarment Certification Form requires the contractor to certify that neither the firm nor any of its owners, partners, directors, officers, principals, or personnel with management or federal fund administration responsibilities are presently debarred, suspended, or excluded from federal or state covered transactions. The contractor must also confirm it has not been convicted of fraud, criminal offenses, antitrust violations, or embezzlement within the preceding three years, is not presently indicted for such offenses, and has not had public contracts terminated for cause or default within three years. Additionally, the contractor must be actively registered with the System for Award Management (SAM) with an assigned DUNS number and must certify it will not enter into transactions with debarred or excluded subcontractors, material suppliers, or vendors. Granite School District reserves the right to accept or reject any submitted alternate products.
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Text version
EXHIBIT “A”
DEBARMENT CERTIFICATION FORM
The Contractor certifies that, neither the Contractor firm nor any owner, partner, director, officer, or principal of the Contractor, nor any person in a position with management responsibility or responsibility for the administration of federal funds:
(a) Is presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by any federal or state department/agency;
(b) Has within a three-year period preceding this certification been convicted of or had a civil judgment rendered against it for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public transaction or contract (federal, state, or local); 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) Is 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 (b) above;
or
(d) Has within a three-year period preceding this certification had one or more public transactions or contracts (federal, state, or local) terminated for cause or default.
(e) The contractor is “Actively” registered with SAMS (Service for Award Management), and has been assigned the following DUNS Number: __________________________.
The Contractor further certifies that it shall not knowingly enter into any transaction with any subcontractor, material supplier, or vendor who is debarred, suspended, declared ineligible, or voluntarily excluded from covered transactions by any federal or state department/agency.
Dated this ___________________ day of _______________, 20 __________
By__________________________________________________________
Authorized Signature for Contractor
Printed Name and Title
File details come from the government source that posted it. Updated .