CertificationRegardingDebarmentandSuspension~1.doc
DOC document 28 KB Posted
- Attached to
- 17CBEHSDMEINCONTINENCERPRODUCTSRFR:RFR for a Preferred Supplier of DME Incontinence Products
- Solicitation number
- BD-17-1039-EHS01-EHS01-14628
- Issued by
- Suffolk County, Massachusetts
About this file
This document is a Certification Regarding Debarment and Suspension for a state and local contract opportunity in Massachusetts. The certification indicates that the vendor is not presently debarred, suspended, proposed for debarment, or voluntarily excluded from contracting with any government entity, and has not been convicted of or charged with certain criminal offenses related to obtaining or performing public contracts.
The state and local contract opportunity is for a "preferred wholesale distributor" arrangement for the supply of incontinence products to participating MassHealth Durable Medical Equipment (DME) Providers, including MassHealth Pharmacy Providers with a DME specialty. The contract will be awarded to a single preferred supplier who can provide incontinence products meeting EOHHS's minimum quality standards at a discounted rate.
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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 com- mission 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 .