CERTIFICATION_OF_CONTRACTOR_REGARDING_DEBARMENT,_SUSPENSION,_AND_OTHER_INELIGIBILITY_AND_VOLUNTARY_EXCLUSION.pdf
PDF 602 KB Posted
- Attached to
- Environmental Services
- Solicitation number
- 2022-13
- Issued by
- Essex County, Kentucky
About this file
The document is a Certification of Contractor Regarding Debarment, Suspension, and Other Ineligibility and Voluntary Exclusion form from Lextran, a transportation agency located in Fayette County, Kentucky. This standard federal certification form requires a contractor to affirm that they are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in federal transactions by any Federal department or agency.
The form provides space for a company to complete its details, including company name, address, contact information, and a signature from an authorized official who certifies the truthfulness of the statements. The certification references 31 U.S.C. Sections 3801 et seq. and requires the signatory to understand the applicable provisions. If the contractor cannot certify the statements, they are instructed to attach an explanation to the proposal. The form is designed to ensure contractors meet federal eligibility requirements before entering into a transaction or contract.
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Text version
CERTIFICATION OF CONTRACTOR REGARDING DEBARMENT, SUSPENSION, AND OTHER
INELIGIBILITY AND VOLUNTARY EXCLUSION
The undersigned, an authorized official of the Proposer stated below, certifies, by submission of this proposal, that neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency.
(If the undersigned is unable to certify to any of the statements in this certification, such official shall attach an explanation to this proposal).
THE UNDERSIGNED CERTIFIES OR AFFIRMS THE TRUTHFULNESS AND ACCURACY OF THE
CONTENTS OF THE STATEMENTS SUBMITTED ON OR WITH THIS CERTIFICATION AND
UNDERSTANDS THAT THE PROVISIONS OF 31 U.S.C. SECTIONS 3801 ET SEQ. ARE APPLICABLE
THERETO.
Company: _______________________________________________________________________
Address: ________________________________________________________________________
City: _______________________________________ State: ___________ Zip: ____________
Contact Name: __________________________________________________________________
Title: ___________________________________ Telephone: _____________________________
Signature: __________________________________________________ Date: ____________________
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File details come from the government source that posted it. Updated .