Contractor_Responsibility_Certification.pdf

CONTRACTOR RESPONSIBILITY CERTIFICATION

The Bidder is required to certify compliance with the following contractor responsibility standards by checking appropriate boxes. For purposes hereof, all relevant time periods are calculated from the date this Certification is executed.

YES NO

1. Has the firm been suspended and/or debarred by any federal, state or local government agency or authority in the past three years?

2. Has any officer, director, or principal of the firm been convicted of a felony relating to your business industry?

3. Has the firm defaulted on any project in the past three (3) years?

4. Has the firm had any type of business, contracting or trade license revoked or suspended for cause by any government agency or authority in the past three (3) years?

5. Has the firm been found in violation of any other law relating to its business, including, but not limited to antitrust laws, licensing laws, tax laws, wage or hour laws, environmental or safety laws, by a final unappealed decision of a court or government agency in the past three (3) years, where the result of such adjudicated violation was a payment of a fine, damages or penalty in excess of $1,000?

6. Has the firm been the subject of voluntary or involuntary bankruptcy proceedings at any time in the past three (3) years?

7. Has the firm successfully provided similar products or performed similar services in the past three (3) years with a satisfactory record of timely deliveries or on-time performance?

8. Does the firm currently possess all applicable business, contractor and/or trade licenses or other appropriate licenses or certifications required by applicable state or local laws to engage in the sale of products or services?

9. Does the firm have all the necessary experience, technical qualifications and resources, including but not limited to equipment, facilities, personnel and financial resources, to successfully provide the referenced product(s) or perform the referenced service(s), or will obtain same through the use of qualified, responsible subcontractors?

10. Does the firm meet all insurance requirements per applicable law or bid specifications including general liability insurance, workers’ compensation insurance, and automobile liability insurance?

11. Firm acknowledges that it must provide appropriate documentation to support this Contractor Responsibility Certification if so requested by the City of Gainesville. The firm also understands that the City of Gainesville may request additional information or documents to evaluate the responsibility of firm. Firm agrees to provide such additional information or supporting documentation for this Certification.

Under the penalty of perjury, the Bidder’s authorized representative hereby certifies that all responses marked in this form or otherwise submitted for purposes of determining the Bidder’s status as a responsible contractor is true, complete and accurate and that he/she has knowledge and authority to verify the information in this certification or otherwise submitted on behalf of the Bidder by his or her signature below.

Company:

Name: ___________________________________________________________________________________________

Title: ____________________________________________________________________________________________

Signature: Date: ______________