6-SAM Certification.pdf

This is a Certification Regarding Debarment, Suspension and Other Responsibility form for the On-Call Maintenance & Stabilization Services contract opportunity with Louisville Metro Government in Kentucky. The form requires the business entity submitting a bid to certify its eligibility and responsibility status as of a specified date. The certifying authorized representative must attest that the business entity and its principals are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in the transaction by any federal department or agency. Alternatively, if the entity is unable to make this certification, it must provide an attached explanation detailing the circumstances.

The form requires completion of standard information including the business entity name, date of certification, signature and printed name of the authorized representative, and the representative's title, role, or capacity. This certification document serves as a prerequisite requirement for bidders on the Louisville Metro Government contract, ensuring compliance with federal eligibility standards prior to contract award consideration.