9-Appendix E Certification Regarding Debarment and Suspension (8).pdf
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- Attached to
- Jefferson Academy- Food Service Management
- Solicitation number
- RA26-146
- Issued by
- Davis County, Utah
About this file
This is a Certification Regarding Debarment and Suspension form required by Jefferson Academy for the Food Service Management contract opportunity in Utah. The certification document implements Executive Order 12549 and 12689 requirements under Title 2 CFR Part 180, establishing eligibility standards for prospective participants bidding on this procurement. Bidders must certify that neither they nor their principals are currently debarred, suspended, proposed for debarment, or voluntarily excluded from federal assistance programs. The form establishes a three-year lookback period for conviction or civil judgment history related to fraud, criminal offenses in connection with public transactions, antitrust violations, embezzlement, theft, forgery, bribery, falsification of records, false statements, or receipt of stolen property. Additionally, bidders must confirm they have not had public transactions terminated for cause or default within the three-year period preceding the application. Questions regarding this RFP must be submitted in writing to njones@jeffersonacademy.org by 6/5/2026 at 5:00 PM MDT, with answers posted on the Utah Public Procurement Place (U3P) portal. Proposals must be submitted to Nicole Jones at 1425 S Angel St. Kaysville, UT 84037 no later than 6/29/2026 at 3:00 PM MDT.
Any prospective participant unable to certify to the statements in this certification must attach a written explanation to their proposal. The certification requires completion with the food service management company (FSMC) name, street address, authorized representative's printed name and title, and the authorized representative's signature. There are no specific pricing terms, set asides, or funding source information contained within this certification document, as it serves solely as a compliance verification form for contractor eligibility and integrity standards.
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Appendix E
Certification Regarding Debarment and Suspension Ineligibility and Voluntary Exclusion
This certification is required by the regulations implementing Executive Order 12549 and 12689, “Debarment and Suspension” (Title 2 CFR Part 180). These regulations restrict awards, subawards, and contracts with certain parties that are debarred, suspended, or otherwise excluded from or ineligible for participation in Federal assistance programs or activities.
1. Certification of Prospective Participant
a. The prospective participant certifies, by submission of this proposal, that neither it nor its principles:
i. Are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency;
ii. 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;
iii. 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
iv. 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 participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal.
Name of FSMC Street Address (City, State. Zip)
Printed Name of FSMC Authorized Representative FSMC Authorized Representative Title
FSMC Authorized Representative Signature
1 Revised: 04/24/2026
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| Name of FSMC: |
| Street Address City State Zip: |
| Printed Name of FSMC Authorized Representative: |
| FSMC Authorized Representative Title: |
| Signature1_es_:signer:signature: |
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