Attachment C - Bidders Disclosure of Prior Non-Responsibility Determinations.pdf
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- Attached to
- Copado DevOps Platform
- Solicitation number
- 2137801
- Issued by
- Albany County, Albany City, New York
About this file
This is a Bidder's Disclosure of Prior Non-Responsibility Determinations form (AF 11, revised 6-06) used by governmental entities to assess bidder eligibility and responsibility. The form requires bidders to disclose whether they or their organization have received non-responsibility findings from any governmental entity within the previous four years. Bidders must indicate whether any such findings were based on violations of State Finance Law 139-j or the intentional provision of false or incomplete information to a governmental entity. The form also requires disclosure of any instances where a governmental entity or other governmental agency terminated or withheld a procurement contract due to intentional provision of false or incomplete information. All responses must be accompanied by detailed explanations, including the name of the governmental entity involved, the date of the finding or termination, and the specific basis for such action.
Bidders must certify that all information provided regarding State Finance Law 139-k compliance is complete, true, and accurate, with the form requiring signature, date, name, and title of the authorized representative submitting the disclosure. This certification serves as a mechanism for governmental entities to evaluate contractor responsibility and past performance in procurement transactions, ensuring that only qualified and trustworthy vendors are eligible to enter into contracts. The form may be supplemented with additional pages as necessary to accommodate detailed explanations of any disclosed findings or contract terminations.
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Text version
AF 11 (6-06)
Attachment C
Bidder’s Disclosure of Prior Non-Responsibility Determinations
Name of Individual or Entity Seeking to Enter into the Procurement Contract:
Address: _______________________________________________________________
Name and Title of Person Submitting this Form: ________________________________
Contract Procurement Number: _____________________________________________
Date:________________________
1. Has any Governmental Entity made a finding of non-responsibility regarding the individual or entity seeking to enter into the Procurement Contract in the previous four years? (Please circle):
No Yes
If yes, please answer the next questions:
2. Was the basis for the finding of non-responsibility due to a violation of State Finance Law §139-j (Please circle):
3. Was the basis for the finding of non-responsibility due to the intentional provision of false or incomplete information to a Governmental Entity? (Please circle):
4. If you answered yes to any of the above questions, please provide details regarding the finding of non-responsibility below.
Governmental Entity: ___________________________________________________________
Date of Finding of Non-responsibility: ______________________________________________
Basis of Finding of Non-Responsibility: _____________________________________________
(Add additional pages as necessary)
AF 11 (6-06)
5. Has any Governmental Entity or other governmental agency terminated or withheld a Procurement Contract with the above-named individual or entity due to the intentional provision of false or incomplete information? (Please circle):
6. If yes, please provide details below.
Governmental Entity: ______________________________________________
Date of Termination or Withholding of Contract: _______________________________________
Basis of Termination or Withholding: ____________________________________________
(Add additional pages as necessary)
Offerer certifies that all information provided to the Governmental Entity with respect to State
Finance Law §139-k is complete, true and accurate.
By: Date:
Signature
Name:
Title:
File details come from the government source that posted it. Updated .