9-Attachment 7 Certification re Debarment Suspension.docx
DOCX document 24 KB Posted
- 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 | ||
| 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 | ||
| 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 .