9-Attachment 7 Certification re Debarment Suspension.docx

DOCX document 24 KB Posted

Attached to
Acquisition and Development of land at 933 W. Highland Avenue, Milwaukee
Solicitation number
RFP-ED2601
Issued by
Milwaukee County, Mattoon Village, Wisconsin

About this file

This is a Certification Regarding Debarment and Suspension document for a contract opportunity in Wisconsin related to the acquisition and development of land at 933 West Highland Avenue in Milwaukee for the County Medical Examiner's Office Building. The applicant certifies that its principals, owners, officers, shareholders, key employees, directors, and member partners are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency, and that they have not been convicted of or had civil judgments rendered against them for fraud, criminal offenses, antitrust violations, embezzlement, theft, forgery, bribery, falsification of records, false statements, or receipt of stolen property within the three-year period preceding the proposal submission.

Additionally, the applicant certifies that no principals, owners, officers, shareholders, key employees, directors, or member partners are presently indicted for or criminally charged with any offenses enumerated in the certification, and that none have had one or more public transactions terminated for cause or default within the three-year period preceding the proposal date. The document requires authorization by signature with the date, printed name, title, and company name provided by an authorized representative of the applicant organization.

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Other files

File Type Posted
4-Attachment 2 EEOC Compliance.docx DOCX document
2-ATTACHMENT A-D.pdf PDF
7-Attachment 5 Vendor Information Sheet.docx DOCX document
8-Attachment 6 Conflict of Interest.docx DOCX document
6-Attachment 4 Exceptions.docx DOCX document
1-RFP Medical Examiner RFP-ED2601.pdf PDF
5-Attachment 3 Sworn Statement of Proposer.docx DOCX document
3-Attachment 1 Proprietary Info Disclosure Form.docx DOCX document

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Text version

ATTACHMENT 7

CERTIFICATION REGARDING DEBARMENT AND SUSPENSION

The applicant certifies to the best of its knowledge and belief that its principals, owners, officers, shareholders, key employees, directors and member partners: (1) are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; (2) have not within a three-year period preceding the date of 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 antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; (3) are not presently indicted for or otherwise criminally charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in (2) of this certification; and (4) have not within a three-year period preceding the date of this proposal had one or more public transactions (Federal, State or local) terminated for cause or default.

Authorized Signature: Date:

Printed Name: Title:

Company:

File details come from the government source that posted it. Updated .