6-SAM Certification.pdf

PDF 74 KB Posted

Attached to
Ballard Park Pavilion Purchase & Installation
Solicitation number
IFB260038
Issued by
Jefferson County, Kentucky

About this file

This is a standard certification form regarding debarment and suspension requirements for bidders participating in federal contract opportunities. The form requires business entities to certify that they and their principals are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in federal transactions by any federal department or agency. Bidders must select one of two options: either certify their eligibility status or indicate their inability to certify with an attached explanation.

The form requires completion by an authorized representative who must provide their signature, printed name, title/role/capacity, and date of certification. This certification serves as a mandatory compliance document to ensure that only eligible contractors participate in federal contracting opportunities, protecting the integrity of the procurement process by excluding entities that have been sanctioned by federal agencies.

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Text version

CERTIFICATION REGARDING

DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY

Business Entity Name

PLEASE MARK ONE:

___ I hereby certify that, as of ________________, to the best of my knowledge and belief, ________________________________________, and its principals are not presently debarred, suspended, proposed for debarment declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency.

___ I am unable to certify to any of the statements in this certification and an explanation is hereby attached.

Signature of Authorized Representative

Printed Name of Authorized Representative

Title, Role or Capacity of Authorized Representative

Date

Printed Name of Authorized Representative:
Title Role or Capacity of Authorized Representative:
Check Box1: Off
Check Box2: Off
Date 1:
Date 2:
Business Entity Name:

File details come from the government source that posted it. Updated .