6-SAM Certification.pdf

This is a certification form regarding debarment, suspension and other responsibility requirements for state and local 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 transactions by any federal department or agency. The form includes two checkbox options: one for entities that can certify compliance with the debarment requirements, and another for entities unable to certify compliance that must provide an attached explanation.

The certification form requires completion of standard identification fields including the business entity name, date of certification, and signature block information for the authorized representative including their printed name, title or capacity, and date of signature. This appears to be a standard compliance document that bidders must complete and submit as part of their proposal submission to demonstrate their eligibility to participate in government contracting opportunities.