5-H. Certification Regarding Debarment.pdf
PDF 641 KB Posted
- Attached to
- Structural Engineering and Parking Deck Inspection Services State and local contract opportunity
- Solicitation number
- 269-2026-135
- Issued by
- Mecklenburg County, Charlotte City, North Carolina
About this file
The document is a Certification Regarding Debarment, Suspension, and Other Responsibility Matters form with the document number 269.2026.135. This certification is a standard compliance document that requires bidders, contractors, or subcontractors to affirm their legal and ethical standing when pursuing a public contract.
The certification requires the bidding entity to confirm that neither the company nor its key personnel (officers, directors, managers, or those with over 10% equity interest) have been debarred, suspended, or excluded from government transactions. The form mandates disclosure of any criminal convictions, civil judgments, or pending indictments related to fraud, embezzlement, theft, bribery, or other misconduct within the past three years. The document explicitly states that providing false information may result in proposal rejection, contract termination, or potential criminal prosecution. The form provides two signature options: one for certifying compliance and another for indicating an inability to certify, which requires an attached explanation.
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Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| 1-A. Bonfire Instructions Procurement Portal.pdf | ||
| 13-269.2026.135 - Solicitation Summary Page.pdf | ||
| 4-E. References Form.pdf | ||
| 8-K. Licensing and Certifications.pdf | ||
| 2-C. Sample Services Contract.pdf | ||
| 9-B. RFP 269.2026.135 - Structural Engineering and Parking Deck Inspection Services.pdf | ||
| 10-G. Key Personnel and Other Resources.pdf | ||
| 11-L. CBI FORM 3 Services - Subcontractor Supplier Utilization Commitment.pdf | ||
| 12-F. Fee Schedule - Cost Breakdown.xlsx | XLSX spreadsheet | |
| 3-D. Proposal Submission Form.pdf | ||
| 6-I. Byrd Anti-Lobbying Certification.pdf | ||
| 7-J. Exceptions to RFP.pdf |
Show all 12
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Text version
269.2026.135
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS
The bidder, contractor, or subcontractor, as appropriate, certifies to the best of its knowledge and belief that neither it nor any of its officers, directors, or managers who will be working under the Contract, or persons or entities holding a greater than (ten percent) 10% equity interest in it (collectively “Principals”):
1. Are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal or state department or agency in the United States;
2. Have 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; violation of federal or state anti-trust or procurement statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;
3. Are presently indicted for or otherwise criminally or civilly charged by a government entity, (federal, state or local) with commission of any of the offenses enumerated in paragraph 2 of this certification; and
4. Have within a three-year period preceding this application/proposal had one or more public transactions (federal, state or local) terminated for cause or default.
I understand that a false statement on this certification may be grounds for rejection of this proposal or termination of the award or in some instances, criminal prosecution.
I hereby certify as stated above:
(Print Name) Signature
Title Date
I am unable to certify to one or more the above statements. Attached is my explanation. [Check box if applicable]
(Print Name) Signature
File details come from the government source that posted it. Updated .