8-Exhibit E - Suspension Debarment.docx
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- Solicitation number
- HCE-2026-00029658
- Issued by
- Dallas County, Texas
About this file
This is a Suspension/Debarment Certification form used by the City of Dallas for HUD-funded projects in Texas. The document serves as a compliance mechanism to ensure that contractors, subcontractors, vendors, and nonprofit sub-recipients selected to work on federally-funded initiatives are not suspended or debarred from federal participation. The form requires completion of thirteen items including project address, contractor identification information (Federal Tax ID Number and UEI Number), organizational structure details for sole proprietorships and corporations (including names and titles of executives and board members), and specification of the federal-funded project(s) under consideration. The certification process involves an online search of the debarred list maintained at www.sam.gov, with results attached to the completed form. The document includes signature lines for both the contractor or principal representative and an office reviewer, along with a final certification by a certifying officer confirming the City of Dallas's compliance with 2 CFR Part 180 and Appendix II to 2 CFR Part 200, Paragraph (I).
The form establishes accountability through a two-step verification process wherein either the responsiveness checklist reviewer or the City's Office of Contract Compliance (OCC) conducts the debarment search and documents findings. The certifying officer, identified as the Department Director or designee, must sign and date the form to formally attest to compliance with federal suspension and debarment regulations. This certification is mandatory for all HUD-funded projects administered by the City of Dallas, including the Youth Homeless and Housing Services Program administered through TDHCA funds, ensuring that only eligible contractors participate in the delivery of services to unaccompanied youth and young adults.
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Text version
Exhibit E Comment by Krol, Kirby: Revised title to match file name Suspension/Debarment Certification
Instructions: Please complete items 1. through 13. below. If an item is not applicable, indicate N/A.
1. Project Address:
2. Completed by:
Name:
Date:
The Suspension/Debarment Certification consists of the responsible department comparing the following contractor information against HUD’s debarred list (available on the Internet at www.sam.gov) and documenting the clearance or rejection of the contractor. By execution of this form, the contractor, subcontractor, vendor, or nonprofit sub-recipient is certifying that the organization and its owner(s) and principal(s) are not suspended or debarred from participation in any HUD-funded contract.
3. Federal Tax ID Number:
4. UEI Number:
5. Name of Contractor:
6. Address of Contractor:
| 7. | Sole Proprietorship: |
| First Name | |
| Middle Name | |
| Last Name |
(List all Partners)
| 8. | Corporation: |
| Title | |
| First Name | |
| Middle Name | |
| Last Name |
| (List all EXECUTIVES and their titles if different than shown) |
| President & Chief Executive Officer, or Executive Director |
Chief Operating Officer
Chief Financial Officer
| 9. | Corporation: |
| Title | |
| First Name | |
| Middle Name | |
| Last Name |
| (List all BOARD MEMBERS in |
| Chair |
| alphabetical order) |
| Vice Chair |
Secretary
Treasurer
Board Member:
Board Member:
Board Member:
Board Member:
Board Member:
Board Member:
Board Member:
Board Member:
Board Member:
Board Member:
Board Member:
(Use additional sheets if needed)
(continued on next page)
10. The above contractor/subcontractor is under consideration for selection to work on the following Federal-funded project(s) _______________________________________________________
11. NAME of Contractor, Subcontractor, Vendor or Nonprofit Sub-recipient
12. SIGNATURE of Owner or Principal
13. DATE
FOR OFFICE USE ONLY:
I hereby certify that I conducted an on-line search of the debarred list found at www.sam.gov based on the information provided by the Contractor above. Results of the search are attached here. Comment by Krol, Kirby: Silly question maybe... but who is the intended reviewer? a.) me conducting the responsiveness checklist, or b.) CCO upon receipt of award recommendation? @Galleshaw, Jessica @Bevel, Mary Comment by Bevel, Mary: OCC reviews this
Signature of Reviewer:
Date:
I hereby certify that, by the completion of this form, the City of Dallas has fully complied with the requirements of 2 CFR Part 180 and Appendix II to 2 CFR Part 200, Paragraph (I), pertaining to not using suspended or debarred contractors to conduct HUD funded projects.
Signature of Certifying Officer:
Date:
Department Director or designee
Attachment E, Page 1 of 2 Rev. 12/01/2016
File details come from the government source that posted it. Updated .