Attachment G - Background Certification Form.pdf
PDF 176 KB Posted
- Solicitation number
- RFP-116165
- Issued by
- Clarke County, Virginia
About this file
Attachment G is a Background Certification Form for RFP #2026-FA01 issued by Culpeper County, Virginia for Forensic Financial Review and Auditing Services. The form establishes mandatory background certification requirements for all personnel performing work under any resulting contract due to the sensitive nature of the engagement, which involves access to County financial records, procurement files, personnel data, and potentially criminal justice information subject to CJIS Security Policy requirements. Proposing firms must certify that all professional employees undergo background checks as part of standard hiring practices and that no proposed personnel have been convicted of felony offenses, crimes involving moral turpitude, fraud, embezzlement, theft, forgery, bribery, falsification or destruction of records, or any offense indicating lack of business integrity or honesty. Additionally, firms must verify that no proposed personnel are subject to pending criminal charges related to financial crimes or dishonesty, have been debarred or suspended from government contracts, or have had professional licenses (CPA, CFE, CFF, or other relevant credentials) revoked, suspended, or subject to disciplinary action. The form requires firms to list all proposed personnel with their titles, roles, and credentials, confirm completion of background checks, and disclose any exceptions to the certifications.
The certification requires firms to conduct criminal background checks and professional license verifications for all assigned personnel and provide results to the County Attorney upon request. Firms must immediately notify the County Attorney of any changes in background status during the engagement term. If access to criminal justice information is required, personnel must comply with CJIS Security Policy requirements, including fingerprint-based background checks, with the firm cooperating fully with all such requirements. Authorized firm representatives executing the form must certify that all information provided is true, complete, and accurate, understanding that material misrepresentation may result in disqualification from the procurement, contract termination, and potential referral to appropriate authorities. The County reserves the right to conduct independent background verifications and require substitution of any personnel who do not meet established requirements.
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ATTACHMENT G FORENSIC FINANCIAL REVIEW AND AUDITING SERVICES RFP #2026-FA01
Attachment G — RFP #2026-FA01 — Culpeper County, Virginia
ATTACHMENT G
Background Certification Form
Culpeper County, Virginia
Purpose: Given the sensitive nature of this engagement, which involves access to County financial records, procurement files, personnel data, and potentially criminal justice information subject to CJIS Security Policy requirements, the County requires background certification for all personnel who will perform work under any resulting contract.
PART 1 — FIRM-LEVEL CERTIFICATION
By signing below, an authorized representative of the firm certifies that:
☐ The firm conducts background checks on all professional employees as part of its standard hiring and engagement practices.
☐ No individual proposed for this engagement has been convicted of a felony, a crime involving moral turpitude, fraud, embezzlement, theft, forgery, bribery, falsification or destruction of records, or any other offense indicating a lack of business integrity or honesty.
☐ No individual proposed for this engagement is currently subject to any pending criminal charges related to financial crimes, fraud, or dishonesty.
☐ No individual proposed for this engagement has been debarred, suspended, or otherwise excluded from participation in government contracts by any federal, state, or local government entity.
☐ No individual proposed for this engagement has had a professional license (CPA, CFE, CFF, or other relevant credential) revoked, suspended, or subject to disciplinary action by any regulatory body.
☐ The firm will conduct or has conducted criminal background checks and professional license verifications for all personnel assigned to this engagement and will provide results to the County Attorney upon request.
☐ The firm will immediately notify the County Attorney if any change in the background status of any assigned personnel occurs during the term of the engagement.
☐ If access to criminal justice information (CJI) is required, the firm acknowledges that personnel accessing such information must comply with CJIS Security Policy requirements, including fingerprint-based background checks, and the firm will cooperate fully with any such requirements.
PART 2 — PROPOSED PERSONNEL
List all personnel proposed for this engagement. Additional pages may be attached if necessary.
Name Title / Role Credentials Background Check Completed (Y/N)
PART 3 — DISCLOSURE OF EXCEPTIONS
☐ There are NO exceptions to the certifications provided in Part 1.
☐ The following exceptions are disclosed (describe below):
CERTIFICATION
I certify that the information provided on this Background Certification Form is true, complete, and accurate.
I understand that any material misrepresentation may result in disqualification from this procurement, termination of any resulting contract, and/or referral to appropriate authorities. I further understand that the County reserves the right to conduct independent background verifications and to require substitution of any personnel who do not meet the County’s requirements.
Firm Name: ____________________________________________________________
Signature:
Printed Name:
Title:
Date:
File details come from the government source that posted it. Updated .