8-Debarment-Suspension Certification Document.pdf
PDF 881 KB Posted
- Solicitation number
- 25/0236
- Issued by
- Harris County, Texas
About this file
This document is a Vendor Certification form from the Harris County Juvenile Probation Department, requiring vendors to certify their legal and ethical standing when participating in public transactions. The certification mandates that vendors and their principals confirm they are not currently debarred, suspended, or excluded from federal transactions, and have not been convicted of fraud, criminal offenses, or other specified misconduct within the past three years. Vendors must either affirm their compliance by checking the "I certify" box or explain their inability to certify if they cannot meet these requirements.
The form is designed to ensure vendor integrity and compliance with federal regulations (specifically 2 CFR Part 180.995), providing a standardized method for vendors to declare their eligibility for public contracts. The document requires vendors to provide their name, a representative's signature, and the date of certification, with space for detailed explanations if they are unable to fully certify their standing. The form was last revised in August 2021 and is specifically tailored to Harris County's procurement processes for the Juvenile Probation Department.
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Text version
rev. 8/2021
HARRIS COUNTY JUVENILE PROBATION DEPARTMENT
VENDOR CERTIFICATION
Vendor certifies that it and its principals (as defined in 2 CFR Part 180.995):
Are not presently debarred, suspended, proposed for debarment, declared ineligible, sentenced to a denial of Federal benefits by a State or Federal Court, or voluntarily excluded from participation in this transaction by any federal department or agency;
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; or
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 the above bullet; and 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.
Select the appropriate response, provide requested information, and sign:
I certify.
I am unable to certify.
If you selected “I am unable to certify”, please provide an explanation as to why the applicant agency cannot certify the statements.
Explanation:________________________________________________________
Vendor Name Representative's Signature
Date
File details come from the government source that posted it. Updated .