7-H. Certification Regarding Debarment.pdf
PDF 685 KB Posted
- Attached to
- Structural Engineering and Parking Deck Inspection Services State and local contract opportunity
- Solicitation number
- 269-2026-160
- Issued by
- Mecklenburg County, Charlotte City, North Carolina
About this file
This document is a Certification Regarding Debarment, Suspension, and Other Responsibility Matters form, designed for bidders, contractors, or subcontractors participating in a government contract. The certification requires the applicant to attest to their legal and ethical standing by confirming that neither the company nor its principals (officers, directors, managers, or entities with over 10% equity interest) have been subject to certain legal actions or convictions.
The form specifically requires the applicant to certify that they: 1) are not currently debarred or suspended from federal or state transactions, 2) have not been convicted of fraud or criminal offenses in public transactions within the past three years, 3) are not currently indicted or criminally charged by a government entity, and 4) have not had public transactions terminated for cause within the past three years. The document includes spaces for the applicant to either certify compliance or provide an explanation if unable to meet these requirements, with a clear warning that false statements may result in proposal rejection, contract termination, or potential criminal prosecution.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| 11-L. Commercial Non-Discrimination.pdf | ||
| 10-K. CBI FORM 3 Services - Subcontractor Supplier Utilization Commitment.pdf | ||
| 12-B. RFQ 269.2026.160 Structural Engineering and Parking Deck Inspection Services.pdf | ||
| 2-C. Sample Services Contract.pdf | ||
| 5-F. Licensing and Certifications.pdf | ||
| 1-A. Bonfire Instructions Procurement Portal.pdf | ||
| 3-D. Submission Form.pdf | ||
| 4-E. References Form.pdf | ||
| 6-G. Key Personnel and Other Resources.pdf | ||
| 8-I. Byrd Anti-Lobbying Certification.pdf | ||
| 9-J. Exceptions to RFQ.pdf |
Show all 11
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Text version
269.2026.160
CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER
RESPONSIBILITY MATTERS
The bidder, contractor, or subcontractor, as appropriate, certifies to the best of its knowledge and belief that neither it nor any of its officers, directors, or managers who will be working under the Contract, or persons or entities holding a greater than (ten percent) 10% equity interest in it (collectively “Principals”):
1. Are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal or state department or agency in the United States;
2. Have within a three-year period preceding this proposal 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 anti-trust or procurement statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;
3. Are presently indicted for or otherwise criminally or civilly charged by a government entity, (federal, state or local) with commission of any of the offenses enumerated in paragraph 2 of this certification; and
4. Have within a three-year period preceding this application/proposal had one or more public transactions (federal, state or local) terminated for cause or default.
I understand that a false statement on this certification may be grounds for rejection of this proposal or termination of the award or in some instances, criminal prosecution.
I hereby certify as stated above:
(Print Name) Signature
Title Date
I am unable to certify to one or more the above statements. Attached is my explanation. [Check box if applicable]
(Print Name) Signature
File details come from the government source that posted it. Updated .