Debarment_and_Suspension_Certification.pdf

DEBARMENT AND SUSPENSION CERTIFICATION

I. PRIMARY CONTRACTOR

In accordance with Title 2 CFR, Part 180, “OMB Guidelines to Agencies on Government wide Debarment and Suspension (nonprocurement)”, the prospective bidder, under penalty of perjury, certifies the following:

A. He/she or any person associated therewith in the capacity of owner, partner, director, officer, or manager, is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by any federal agency; has not been suspended, debarred, voluntarily excluded, or determined ineligible by any federal agency within the past three (3) years; does not have a proposed debarment pending; and has not been indicted, convicted, or had a civil judgment rendered against it by a court of competent jurisdiction in any matter involving fraud or official misconduct within the past three (3) years. Any exceptions to this certification must be disclosed to City of Pasadena;

B. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph (A) of this certification;

and

C. Have not within a three-year period preceding this application/bid had one or more public transactions (Federal, State or local) terminated for cause or default.

If unable to certify any or all aforementioned statements, the Contractor shall attach an explanation to this Form.

Exceptions will not necessarily result in denial of recommendation for award, but will be considered in determining Bidder’s responsibility. Disclosures must indicate to whom exceptions apply, initiating agency, and dates of action.

Exceptions to the Federal Government Excluded Parties List System maintained by the General Services Administration are to be determined by the Federal Agency.

[Name] [Title] [Signature] [Date]

PROJECT:

DEBARMENT AND SUSPENSION CERTIFICATION

I. LOWER TIER COVERED TRANSACTIONS (SUBCONTRACTORS)

In accordance with Title 2 CFR, Part 180, “OMB Guidelines to Agencies on Government wide Debarment and Suspension (nonprocurement)”, the lower tier entity of ___________________________ (Contractor), under penalty of perjury, certifies the following:

A. He/she or any person associated therewith in the capacity of owner, partner, director, officer, or manager, is not currently under suspension, debarment, voluntary exclusion, or determination of ineligibility by any federal agency; has not been suspended, debarred, voluntarily excluded, or determined ineligible by any federal agency within the past three (3) years; does not have a proposed debarment pending; and has not been indicted, convicted, or had a civil judgment rendered against it by a court of competent jurisdiction in any matter involving fraud or official misconduct within the past three (3) years. Any exceptions to this certification must be disclosed to City of Pasadena;

B. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph (A) of this certification;

and

C. Have not within a three-year period preceding this application/bid had one or more public transactions (Federal, State or local) terminated for cause or default.

If unable to certify any or all aforementioned statements, the Subcontractor shall attach an explanation to this Form.

Exceptions will not necessarily result in denial of recommendation for award, but will be considered in determining Bidder’s responsibility. Disclosures must indicate to whom exceptions apply, initiating agency, and dates of action.

Exceptions to the Federal Government Excluded Parties List System maintained by the General Services Administration are to be determined by the Federal Agency.

Lower Tier Participant:___________________________________________

[FIRM NAME]

[Name] [Title] [Signature] [Date]

PROJECT: