7-GSD - Exhibit A - Debarment Certification Form.pdf
PDF 36 KB Posted
- Attached to
- Steinway Piano- Notice of Intent to Award Without Engaging in a Standard Procurement Process
- Solicitation number
- AP27-601-SS
- Issued by
- Salt Lake County, Utah
About this file
This is a Debarment Certification Form (Exhibit A) associated with a Notice of Intent to Award procurement by Granite School District in Utah for the purchase of a Steinway Piano without engaging in a standard procurement process. The form serves as a certification document that must be completed by the contractor prior to contract award. The debarment certification requires the contractor to confirm that neither the firm nor any of its owners, partners, directors, officers, principals, or management-level personnel have been debarred, suspended, proposed for debarment, or excluded from covered transactions by any federal or state department or agency.
The certification further requires the contractor to attest that within the three-year period preceding the certification, the firm has not been convicted of or had a civil judgment rendered against it for fraud, criminal offenses related to public transactions, violations of antitrust statutes, embezzlement, theft, forgery, bribery, falsification of records, false statements, or receipt of stolen property. The contractor must also confirm that it is not currently indicted or criminally or civilly charged with any such offenses, and that it has not had any public contracts terminated for cause or default within the preceding three years. Additionally, the contractor must verify active registration with the System for Award Management (SAM) and provide its assigned DUNS Number. The form requires the contractor to commit to not entering into transactions with any debarred or excluded subcontractors, material suppliers, or vendors.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
EXHIBIT “A”
DEBARMENT CERTIFICATION FORM
The Contractor certifies that, neither the Contractor firm nor any owner, partner, director, officer, or principal of the Contractor, nor any person in a position with management responsibility or responsibility for the administration of federal funds:
(a) Is presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by any federal or state department/agency;
(b) Has within a three-year period preceding this certification been convicted of or had a civil judgment rendered against it for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public transaction or contract (federal, state, or local); 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) Is 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 (b) above;
or
(d) Has within a three-year period preceding this certification had one or more public transactions or contracts (federal, state, or local) terminated for cause or default.
(e) The contractor is “Actively” registered with SAMS (Service for Award Management), and has been assigned the following DUNS Number: __________________________.
The Contractor further certifies that it shall not knowingly enter into any transaction with any subcontractor, material supplier, or vendor who is debarred, suspended, declared ineligible, or voluntarily excluded from covered transactions by any federal or state department/agency.
Dated this ___________________ day of _______________, 20 __________
By__________________________________________________________
Authorized Signature for Contractor
Printed Name and Title
File details come from the government source that posted it. Updated .