7-Debarment and Suspension Certification - Form.pdf
PDF 51 KB Posted
- Solicitation number
- RFQ PK-04-25
- Issued by
- Travis County, Texas
About this file
This document is a Debarment and Suspension Certification form from the City of San Angelo, Texas Purchasing Division, located at 72 West College Avenue in San Angelo. The form requires a prospective primary vendor to certify their legal and ethical standing in relation to federal, state, and local government transactions.
The certification requires vendors to attest that they are not currently debarred, suspended, or excluded from government transactions, have not been convicted of fraud or criminal offenses in the past three years related to public transactions, are not currently indicted for such offenses, and have not had public transactions terminated for cause or default during the preceding three-year period. If a vendor cannot certify to any of these statements, they are required to attach an explanation to their bid. The form provides space for an authorized agent to print their name, title, and provide a signature and date of certification.
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Text version
CITY OF SAN ANGELO, TEXAS
PURCHASING DIVISION
72 West College Avenue, San Angelo, Texas 76903
325.657.4219 • sapurch@cosatx.us
CITY OF SAN ANGELO, TEXAS • DEBARMENT AND SUSPENSION CERTIFICATION
Debarment and Suspension Certification
(1) The prospective primary vendor certifies to the best of its knowledge and belief that it and its principals:
(a) Are not presently debarred, suspended, proposed for disbarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency;
(b) Have not within a three-year period preceding this application been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;
(c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this certification; and
(d) Have not within a three-year period preceding this application had one or more public transactions (Federal, State, or local) terminated for cause or default.
(2) Where the prospective primary vendor is unable to certify to any of the statements in this certification, such prospective primary vendor shall attach an explanation to this bid.
AUTHORIZED AGENT • PLEASE PRINT
VENDOR
NAME TITLE
SIGNATURE
DATE
mailto:sapurch@cosatx.us
Debarment and Suspension Certification
File details come from the government source that posted it. Updated .