5-H. CERTIFICATION REGARDING DEBARMENT.pdf
PDF 145 KB Posted
- Attached to
- Investment Custodian and Trustee Services
- Solicitation number
- 269- 2026-110
- Issued by
- Mecklenburg County, Charlotte City, North Carolina
About this file
This is a Certification Regarding Debarment document required for a bid submission to the City of North Carolina for Investment Custodian and Trustee Services. The certification requires bidders, contractors, and subcontractors to attest that they and their principals—including officers, directors, managers, and individuals holding greater than 10% equity interest—are not currently debarred, suspended, proposed for debarment, or voluntarily excluded from covered transactions by any federal or state department or agency. The document mandates disclosure of any convictions or civil judgments within the three-year period preceding the proposal for fraud, criminal offenses related to public transactions, violations of federal or state anti-trust or procurement statutes, embezzlement, theft, forgery, bribery, falsification of records, false statements, or receipt of stolen property.
The certification also requires disclosure of any current indictments or criminal or civil charges by a government entity related to the offenses enumerated above, as well as any public transactions terminated for cause or default within three years preceding the application. Bidders must certify under penalty of potential rejection, award termination, or criminal prosecution for false statements. An optional checkbox allows bidders unable to certify to one or more statements to attach an explanation. The document requires signature, printed name, title, and date from the authorized representative.
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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 .