Attachment_4_-_General_Certifications_Form.docx
DOCX document 29 KB Posted
- Attached to
- RFP 25-10 Labor Consultant
- Solicitation number
- 0000037659
- Issued by
- San Bernardino County, California
About this file
This is a General Certifications Form for RFP 25-10 Labor Consultant issued by a California court. The form requires bidders to certify compliance with multiple conflict of interest and eligibility requirements before submission. Bidders must confirm they have no conflicts of interest under California Public Contract Code sections 10365.5, 10410, or 10411, Government Code sections 1090 or 87100 et seq., or California Rules of Court rules 10.103 or 10.104. The form must be completed and signed by an authorized representative and returned with the bid or proposal; failure to include this properly executed attachment will result in bid rejection.
The certification form requires bidders to verify they are not suspended or debarred from state contracting, not listed on the California Franchise Tax Board's or Board of Equalization's lists of largest tax delinquencies, and either not a scrutinized company under Public Contract Code section 10490(b) or not providing goods or services related to conflict minerals compliance under Section 13(p) of the Securities Exchange Act of 1934. Bidders must provide their legal company name, signature, execution date, and the printed name and title of the authorized signing officer on the form.
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| Attachment_7B_-_DVBE_Declaration.docx | DOCX document | |
| Exhibit_A_-_Statement_of_Work.docx | DOCX document | |
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| Attachment_3_-_Acceptance_of_Terms_and_Conditions.docx | DOCX document | |
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Text version
RFP 25-10 Labor Consultant
ATTACHMENT 4
GENERAL CERTIFICATIONS FORM
Read the following clauses carefully. If agreed, sign this attachment and return with your bid or proposal. Please note that the Court will reject any bid or proposal that does not include this properly completed and signed attachment.
Conflict of Interest. Bidder has no interest that would constitute a conflict of interest under California Public Contract Code (PCC) sections 10365.5, 10410 or 10411; Government Code sections 1090 et seq. or 87100 et seq.; or California Rules of Court, rule 10.103 or 10.104, which restrict employees and former employees from contracting with judicial branch entities.
Suspension or Debarment. Bidder certifies that neither Bidder nor any of Bidder’s intended subcontractors is on the California Department of General Services’ list of firms and persons that have been suspended or debarred from contracting with the state because of a violation of PCC 10115.10, regarding disabled veteran business enterprises.
Tax Delinquency. Bidder certifies that it is not on either (i) the California Franchise Tax Board’s list of 500 largest state income tax delinquencies, or (ii) the California Board of Equalization’s list of 500 largest delinquent sales and use tax accounts.
Conflict Minerals. Bidder certifies that either (i) it is not a scrutinized company as defined in PCC 10490(b), or (ii) the goods or services the Bidder would provide to the Court are not related to products or services that are the reason the Bidder must comply with Section 13(p) of the Securities Exchange Act of 1934. (Note: PCC 10490(b) defines a “scrutinized company” as “a person that has been found to be in violation of Section 13(p) of the Securities Exchange Act of 1934 by final judgment or settlement entered in a civil or administrative action brought by the Securities and Exchange Commission and the person has not remedied or cured the violation in a manner accepted by the commission on or before final judgment or settlement.”)
By signing below, signer indicates acceptance of the clauses above on behalf of Bidder and certifies they are duly authorized to legally bind the Bidder:
Legal Name of Company (Printed):
| Signature: |
| Date Executed: |
Printed Name and Title of Person Signing:
Rev. 2020-07 Page 1 of 1
File details come from the government source that posted it. Updated .