Cert_Non_State_Emp.doc

DOC document 24 KB Posted

Attached to
Medical and Psychological Consultative Evaluations
Solicitation number
BD-21-1071-DDS-MEDR1-63004
Issued by
Middlesex County, Massachusetts

About this file

This document is a certification form for a state and local contract opportunity in Massachusetts for Medical and Psychological Consultative Evaluations. The form requires the signer to certify that they are not a current state employee and will not seek such employment during the contract period, including any option years. Failure to certify this information or providing false information would result in the signer being ineligible for award of the contract or potential termination of any resulting contract.

The contract opportunity is for Medical and Psychological Consultative Evaluations services within the state of Massachusetts. No additional details are provided about the specific products or services requested, quantities, response dates, award information, or contract term.

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Certification as Non-state employee I hereby certify that I am not an employee with any State Agency. Furthermore, I also certify that I will not seek such employment during the period of performance specified in this contract, including option years if exercised.

Note:

The Contractor is hereby informed that if unable to certify the above information, he/she may not be considered for award of a contract. Any false information given will be grounds for termination of any resulting contract.

Signature

Date

File details come from the government source that posted it. Updated .