6-H. CERTIFICATION REGARDING DEBARMENT.pdf
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- Solicitation number
- 269- 2026-142
- Issued by
- Mecklenburg County, Charlotte City, North Carolina
About this file
This is a Certification Regarding Debarment, Suspension, and Other Responsibility Matters form for the City of North Carolina's Citywide On-Call Fencing Installation and Repair Services contract opportunity. The certification requires bidders, contractors, or subcontractors to affirm that neither they nor their officers, directors, managers, or principals holding greater than ten percent equity interest are presently debarred, suspended, proposed for debarment, or voluntarily excluded from covered transactions by any federal or state department or agency. The form also requires certification that within the three-year period preceding the proposal, the bidder and its principals have not been convicted of or had civil judgments rendered against them for fraud, criminal offenses related to public transactions, violations of federal or state anti-trust or procurement statutes, embezzlement, theft, forgery, bribery, falsification or destruction of records, false statements, or receipt of stolen property.
The certification further requires attestation that the bidder is not presently indicted for or criminally or civilly charged with any offenses enumerated in the certification and that within three years preceding the proposal, no public transactions have been terminated for cause or default. Bidders must acknowledge that false statements on this certification may result in proposal rejection, award termination, or criminal prosecution. The form provides space for the bidder's printed name, signature, title, and date, with an optional checkbox and space for explanation if the bidder is unable to certify to one or more statements.
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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 .