6-G. Certification Regarding Debarment.pdf
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- Attached to
- Median Maintenance Services
- Solicitation number
- 269-2026-149
- Issued by
- Mecklenburg County, Charlotte City, North Carolina
About this file
This document is a Certification Regarding Debarment, Suspension, and Other Responsibility Matters form, applicable to bidders, contractors, or subcontractors participating in a public transaction. The certification requires disclosure of any past or present legal issues that would potentially disqualify an entity from participating in federal, state, or local government contracts.
The form requires the bidding entity to certify that neither the company nor its key personnel (officers, directors, managers, or those with >10% equity interest) have been debarred, suspended, or made ineligible for public transactions. Specifically, the certification covers whether the entity has been convicted of fraud, criminal offenses, anti-trust violations, or other financial misconduct within the past three years, or has been terminated from previous public transactions. The document provides two signature lines - one for certification and another for explaining any inability to fully certify the statements, with the understanding that false statements may result in proposal rejection or potential criminal prosecution.
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Text version
269.2026.149
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 .