6-Part G - Attachment A - Authorized Signatory Statement.pdf
PDF 162 KB Posted
- Attached to
- Organizational Assessment and Integration Study
- Solicitation number
- 2030
- Issued by
- Alexandria City, Virginia
About this file
This is an Authorized Signatory Statement form issued by the City of Alexandria for a solicitation related to an Organizational Assessment and Integration Study in Virginia. The form serves as a certification document that must be completed and signed by an authorized representative of the responding organization. The signatory must confirm authority to submit the response on behalf of the respondent, validate that the submission is firm and will remain effective for the period specified in the solicitation documents, and acknowledge understanding and compliance with all solicitation requirements including instructions, specifications, evaluation criteria, terms and conditions, and any issued addenda.
The form requires the respondent to certify several critical compliance matters, including that the response was prepared independently without collusion with other respondents, that no gratuities or kickbacks have been offered to City employees or officials in connection with the solicitation, that a drug-free workplace will be maintained where required by Virginia law, and that all submitted information is true, complete, and accurate. The signatory must provide their authorized signature, date, printed name, title, respondent legal name, address, and contact information. The form explicitly warns that false certifications may result in criminal and civil penalties, and material misrepresentations may lead to response rejection, termination of negotiations, termination for default, or other remedies available to the City.
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City of Alexandria
Attachment A Authorized Signatory Statement
By signing below, the undersigned certifies and represents that:
1. Authority / Binding Offer: The undersigned is an officer, partner, member, manager, or duly authorized agent of the Respondent with full authority to submit this Response on behalf of the Respondent and to bind the Respondent to the representations made herein and to the requirements of this Solicitation.
2. Validity of Response: This Response constitutes a firm and valid submission for evaluation purposes and shall remain effective for the period stated in the Solicitation Documents, or, if no period is stated, for a reasonable period as determined by the City.
3. Acknowledgment of Solicitation Requirements: The Respondent acknowledges that it has read, understands, and agrees to comply with all requirements of the Solicitation Documents, including all instructions, specifications or scope, evaluation criteria, applicable terms and conditions, and all addenda issued by the City (as acknowledged by the Respondent).
4. No Collusion / Independent Submission: The Respondent certifies that this Response has been prepared and submitted independently and without collusion, consultation, communication, or agreement with any other respondent, bidder, or offeror regarding prices, qualifications, intent to submit, or response terms, except as expressly permitted by law. The Respondent understands that false certification may subject it to criminal and civil penalties.
5. Ethics in Public Contracting: The Respondent certifies that it has not offered, given, or agreed to give any City employee or official any gratuity, kickback, or thing of value in connection with this Solicitation and will comply with all applicable ethics in public contracting requirements
6. Drug-Free Workplace (when applicable): Where required by Virginia law and/or the Solicitation Documents, the Respondent certifies that it will provide and maintain a drug-free workplace during performance of any resulting contract and will include the required provisions in subcontracts.
7. Accuracy / Non-Misrepresentation: The Respondent certifies that all information submitted in its Response is true, complete, and accurate, and to the best of its knowledge and acknowledges that any material misrepresentation may result in rejection of the Response, termination of negotiations, termination for default, and/or other remedies available to the City.
Authorized Signature: Date:
Printed Name: Title:
Respondent Legal Name:
Address:
Phone/Email: _________________________________________________________________
No.:
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