5-H. CERTIFICATION REGARDING DEBARMENT.pdf
PDF 145 KB Posted
- Attached to
- General Vehicle Collision Repair Services
- Solicitation number
- 269- 2026-116
- Issued by
- Mecklenburg County, Cleveland Town, North Carolina
About this file
This document is a Certification Regarding Debarment, Suspension, and Other Responsibility Matters form designed for bidders, contractors, or subcontractors to complete when participating in a government contract opportunity. The form requires the entity to certify that neither the organization nor its principals (officers, directors, managers, or those with greater than 10% equity interest) meet certain disqualifying conditions related to legal and ethical business practices.
The certification requires the bidder to confirm they are not currently debarred, suspended, or excluded from government transactions, have not been convicted of fraud or criminal offenses in public transactions within the past three years, are not currently indicted or charged with specified offenses, and have not had public transactions terminated for cause during the preceding three-year period. The form includes a warning that providing a false statement may result in proposal rejection, award termination, or potential criminal prosecution. Signatories must either certify compliance with these conditions or provide an explanation if they cannot fully certify the statements.
View the file
Other files
Show all 11
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
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
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS
File details come from the government source that posted it. Updated .