Certification Regarding Debarment and Suspension~4.docx
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- Solicitation number
- BD-19-1039-EHS01-EHS01-39914
- Issued by
- Middlesex County, Massachusetts
About this file
The document is a Certification Regarding Debarment and Suspension for a state and local contract opportunity titled "19CBBORIMLICENSERFR: RFR for the Physician Online Initial Licensing Application" issued by the Executive Office of Health and Human Services (EOHHS) on behalf of the Commonwealth of Massachusetts Board of Registration in Medicine (BORIM). The scope of work includes developing, implementing, maintaining, and supporting an Online Initial Licensing Application integrated with BORIM's existing applications, as well as providing Managed Support Services (MMIS) for BORIM's Applications Portfolio.
The certification requires the vendor to attest that neither the vendor nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from contracting with any government entity. The vendor must also confirm that it has not been convicted of or had a civil judgment rendered against it for any relevant offenses within the last three years, and is not currently indicted or otherwise criminally or civilly charged by a governmental entity.
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Text version
Certification Regarding Debarment and Suspension
The undersigned (authorized official signing for Vendor ) certifies to the best of his or her knowledge and belief, that Vendor and its principals:
(a) are not presently debarred, suspended, proposed for debarment, declared ineligible, under any federal, state, or local law or regulation, including Executive Order 147; G.L. c. 29, s. 29F G.L. c.30, § 39R, G.L. c.149, § 27C, G.L. c.149, § 44C, G.L. c.149, § 148B and G.L. c. 152, s. 25C or voluntarily excluded from contracting with or being a contractor of a government entity (federal, state or local);
(b) have not received a notice from any government entity regarding a proposed suspension or investigation of a violation of any federal or state law that could result in debarment from contracting with or being a contractor of any federal or state agency;
(c) have not within the last 3-years been convicted of or 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;
(d) are not presently indicted or otherwise criminally or civilly charged by a governmental entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (b) of this certification; and
(e) have not within the last 3 years had one or more public transactions (federal, state, or local) terminated for cause or default.
Vendor:
Signed (by authorized signatory):
Print name:
Title:
Date:
File details come from the government source that posted it. Updated .