Attachment G Form_Certification-of-Financial-Condition_09.2021.pdf
PDF 142 KB Posted
- Attached to
- Keihin Auditorium LED Lighting Upgrade
- Solicitation number
- 95-95-ECC12122024
- Issued by
- Durham County, North Carolina
About this file
This document is North Carolina's Certification of Financial Condition form (Attachment G) used for state contracting, specifically related to the Keihin Auditorium LED Lighting Upgrade project at Edgecombe Community College Tarboro Campus. The form requires vendors to certify several aspects of their financial condition through a checklist format, including confirmation of sound financial standing, unqualified audit opinions, tax compliance, and absence of litigation or compliance issues.
The certification form requires vendors to disclose their latest audit date and explain any missing audits from the past 18 months. If any certification boxes are left unchecked, vendors must provide detailed explanations in the space provided, with failure to do so potentially resulting in the vendor being deemed non-responsive and their submission rejected. The form must be signed by an authorized representative of the vendor and includes a continuing certification clause requiring notification of any material changes within 30 days to the Contract Lead.
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Text version
North Carolina Certification of Financial Condition Version Date: 09/2021
Page | 1
ATTACHMENT G: CERTIFICATION OF FINANCIAL CONDITION
Solicitation #: __________________________
Vendor Name: __________________________
The undersigned hereby certifies that: [check all applicable boxes]
☐ The Vendor is in sound financial condition and, if applicable, has received an unqualified audit opinion for the latest audit of its financial statements.
Date of latest audit: ____________________ (If no audit within past 18 months, explain reason below.)
☐ The Vendor has no outstanding liabilities, including tax and judgment liens, to the Internal Revenue Service or any other government entity.
☐ The Vendor is current in all amounts due for payments of federal and state taxes and required employment-related contributions and withholdings.
☐ The Vendor is not the subject of any current litigation or findings of noncompliance under federal or state law.
☐ The Vendor has not been the subject of any past or current litigation, findings in any past litigation, or findings of noncompliance under federal or state law that may impact in any way its ability to fulfill the requirements of this Contract.
☐ He or she is authorized to make the foregoing statements on behalf of the Vendor.
Note: This shall constitute a continuing certification and Vendor shall notify the Contract Lead within 30 days of any material change to any of the representations made herein.
If any one or more of the foregoing boxes is NOT checked, Vendor shall explain the reason(s) in the space below. Failure to include an explanation may result in Vendor being deemed non-responsive and its submission rejected in its entirety.
Signature Date
Printed Name Title
[This Certification must be signed by an individual authorized to speak for the Vendor]
ATTACHMENT G: CERTIFICATION OF FINANCIAL CONDITION
| Solicitation: |
| Vendor Name: |
| The Vendor is in sound financial condition and if applicable has received an unqualified audit: Off |
| The Vendor has no outstanding liabilities including tax and judgment liens to the Internal Revenue: Off |
| The Vendor is current in all amounts due for payments of federal and state taxes and required: Off |
| The Vendor is not the subject of any current litigation or findings of noncompliance under federal or: Off |
| The Vendor has not been the subject of any past or current litigation findings in any past litigation: Off |
| He or she is authorized to make the foregoing statements on behalf of the Vendor: Off |
| If no audit within past 18 months explain reason: |
| 1: |
| Date: |
| Printed Name: |
| Title: |
File details come from the government source that posted it. Updated .