Attachment_C_Debarment_Form.pdf

This is a Debarment Certification Form for a subcontractor participating in a flood mitigation reconstruction project with the City of Port Orange, Florida, and involving FEMA funding under DEM Contract Number 4680-029-R and FEMA Project Number H1301. The form serves as a certification document that the prospective subcontractor, along with its principals and affiliates, certifies that it is not presently debarred, suspended, proposed for debarment, declared ineligible, voluntarily excluded, or disqualified from participation in any Federal department or agency transactions. This certification is required as part of the subcontracting process for the home rebuild project, which involves the installation of a new elevated manufactured home in a Port Orange manufactured home park community.

The form requires signature authorization from the sub-recipient (City of Port Orange) and includes standard fields for contractor identification, street address, city, state, zip code, and the date of certification. This debarment certification is a prerequisite compliance document necessary for subcontractor eligibility and participation in federally funded disaster recovery projects, ensuring that all participating entities meet federal standards for contractor responsibility and integrity.