Aff A SCWSFA Proposal Certification Form.docx

RFP 2024 – 022 Progressive Design-Build Services for 2024 Sewer Implementation Affidavit “A” PROPOSAL CERTIFICATION FORM I, ______________________________, being duly sworn, state that I am ______________ ________ (title) of ________________________________________ (firm) and hereby duly certify that I have read and understand the information presented in the attached Proposal and any enclosure and exhibits thereto.

I further certify that to the best of my knowledge the information given in response to the Request for Proposals is full, complete, and truthful.

I further certify that the Proposer and any principal employee of the Proposer has not, in the immediately preceding five (5) years, been convicted of any crime of moral turpitude or any felony offense, nor has had their professional license suspended, revoked, or been subjected to disciplinary proceedings.

I further certify that the Proposer has not in the immediately preceding five (5) years been defaulted in any federal, state, or local government agency contract and further, that the Proposer is not now under any notice of intent to default on any such contract.

I acknowledge, agree, and authorize and certify that the Proposer acknowledges, agrees, and authorizes that Spalding County Water & Sewerage Facilities Authority may, by means that it deems appropriate, determine the accuracy and truth of the information provided by the proposer in its Proposal and that the Authority may contact any individual or entity named in the Proposal for the purpose of verifying the information supplied therein.

I acknowledge and agree that all of the information contained in the Proposal is submitted for the express purpose of inducing Spalding County Water & Sewerage Facilities Authority to award a contract.

A materially false statement or omission made in conjunction with this Proposal is sufficient cause for suspension or debarment from further contracts, or denial of rescission of any contract entered into based upon this Proposal thereby precluding the Firm from doing business with, or performing work for, Spalding County Water & Sewerage Facilities Authority. In addition, such false statement or omission may subject the person and entity making the Proposal to criminal prosecution under the laws of the State of Georgia of the United States, including but not limited to OCGA §16- 10-20, 18 USC §§1001 or 1341.

Sworn and subscribed before me This _____ day of ______________, 2024.

NOTARY PUBLIC

NOTARY SEAL

My Commission Expires: _______________________