6-G. Certification Regarding Debarment.pdf
PDF 641 KB Posted
- Attached to
- Water Mitigation and Emergency Clean-Up Services
- Solicitation number
- 269-2026-186
- Issued by
- Mecklenburg County, Charlotte City, North Carolina
About this file
This is a Certification Regarding Debarment, Suspension, and Other Responsibility Matters form required for bidders, contractors, or subcontractors on a Water Mitigation and Emergency Clean-Up Services contract with the City of Charlotte, North Carolina. The certification applies to all principals of the bidding entity, including officers, directors, managers who will work under the contract, and persons or entities holding greater than 10% equity interest. Bidders must certify that neither they nor their principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal or state department or agency.
The certification requires bidders to attest that within the three-year period preceding the proposal, neither they nor their principals have been convicted of or had civil judgments rendered against them for fraud, criminal offenses in connection with public transactions or contracts, violations of federal or state anti-trust or procurement statutes, or crimes including embezzlement, theft, forgery, bribery, falsification or destruction of records, false statements, or receiving stolen property. Additionally, bidders must confirm they are not presently indicted for or criminally or civilly charged with any such offenses and have not had one or more public transactions terminated for cause or default within the preceding three-year period. False statements on this certification may result in proposal rejection, award termination, or criminal prosecution. The form requires the bidder's printed name, signature, title, and date, with an optional checkbox and explanation section if unable to certify to one or more statements.
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Text version
269.2026.186
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 .