Attachment_5_-_General_Certifications_Form.pdf
PDF 704 KB Posted
- Attached to
- RFA 20-20 Court Appointed Psychiatric Services
- Solicitation number
- 0000015808
- Issued by
- San Bernardino County, California
About this file
The document is a General Certifications Form related to a Request for Proposal (RFA) from the State of California for Court Appointed Psychiatric Services in the jurisdictions of San Bernardino County and San Bernardino City. The form requires the bidder to certify that they do not have any conflicts of interest, have not been suspended or debarred, are not tax delinquent, and are not a scrutinized company with regards to conflict minerals. The bidder must check a box and provide an authorized signature to indicate acceptance of these clauses.
The RFA 20-20 Court Appointed Psychiatric Services contract opportunity is for the provision of court-appointed psychiatric services in the specified California jurisdictions. No additional details on quantities, response dates, award dates, or contract term are provided in the available information.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
GENERAL CERTIFICATIONS FORM
Check the box below, if agreed, and sign this attachment. Please note that the Court will reject a proposal from a Bidder that does not indicate acceptance of these clauses.
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.”)
Check box to indicate acceptance of the clauses above.
COMPANY NAME
BY (Authorized Signature)
PRINTED NAME AND TITLE OF PERSON SIGNING
DATE SIGNED
ATTACHMENT 5
File details come from the government source that posted it. Updated .