Attachment_H_Debarment_and_Suspension_Certification.pdf
PDF 117 KB Posted
- Attached to
- Body Shop Repairs
- Solicitation number
- ITB 0029-24
- Issued by
- Lee County, Fort Lauderdale City, Florida
About this file
The document is a Debarment and Suspension Certification form for the City of Fort Myers, Florida, related to a Fleet Auto Body Repair contract opportunity. This attachment requires the prospective primary Respondent to certify their legal and ethical standing in government transactions, specifically affirming that they have not been debarred, suspended, or excluded from federal, state, or local government contracts.
The certification requires the Respondent to confirm they have not been convicted of fraud, criminal offenses, or civil judgments related to public transactions within the past three years, and have not had public transactions terminated for cause or default. If the Respondent cannot certify any of these statements, they are required to attach an explanation to the submittal. The form includes spaces for the business name, date, authorized representative's name, title, and signature, providing a formal mechanism for the Respondent to attest to their compliance with government contracting standards.
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Text version
ATTACHMENT H
DEBARMENT AND SUSPENSION CERTIFICATION
(1) The prospective primary Respondent certifies to the best of its knowledge and belief that it and its principals:
(a) Are not presently debarred, suspended, proposed for disbarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency.
(b) Have not within a three-year period preceding this application been convicted of had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or Local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property.
(c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this certification.
(d) Have not within a three-year period preceding this application had one or more public transactions (Federal, State, or local) terminated for cause or default.
(2) Where the prospective primary Respondent is unable to certify to any of the statements in this certification, such prospective primary Respondent shall attach an explanation to this submittal.
Date: ____________________
Business Name: ________________________________________________
Name of Authorized Representative
Title of Authorized Representative
Signature of Authorized Representative
File details come from the government source that posted it. Updated .