6-SAM Certification.pdf

This is a Certification Regarding Debarment, Suspension and Other Responsibility form related to a Preservation Design Consultant contract opportunity with the Kentucky Office of Planning. The form serves as a compliance document requiring an authorized representative of a business entity to certify that the entity and its principals are not currently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in federal transactions by any federal department or agency as of a specified date.

The form provides two certification options: the first allows the authorized representative to affirm that the business entity meets responsibility requirements, while the second permits submission if the representative is unable to certify and must provide an explanation. The document requires the business entity name, signature and printed name of the authorized representative, their title or role, and the date of certification. This standard federal form is a prerequisite documentation requirement for bidders responding to the state and local contract opportunity for creating an illustrated version of updated Standard Design Guidelines.