Debarment_and_Suspension_Certification.pdf
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- Solicitation number
- 2024-RFP-0637
- Issued by
- Los Angeles County, California
About this file
This document is a Debarment and Suspension Certification form for the City of Pasadena, aligned with Title 2 CFR, Part 180, "OMB Guidelines to Agencies on Government wide Debarment and Suspension (nonprocurement)". The form requires both primary contractors and lower tier subcontractors to certify their legal standing regarding federal agency interactions, legal proceedings, and public transaction history. Specifically, the certification requires attestation that the contractor and associated individuals are not currently suspended, debarred, or voluntarily excluded by any federal agency, have not been suspended or debarred within the past three years, do not have a pending debarment, and have not been indicted, convicted, or had civil judgments rendered against them involving fraud or official misconduct.
The certification form mandates that any exceptions to these statements must be disclosed to the City of Pasadena, with the understanding that such exceptions will not automatically result in denial of award recommendation but will be considered in determining the bidder's responsibility. The form provides space for both primary contractors and subcontractors to sign, date, and provide their name, title, and firm name. The document emphasizes that exceptions to the Federal Government Excluded Parties List System maintained by the General Services Administration are to be determined by the relevant Federal Agency.
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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:
| SMALL MINORITY AND WOMENS BUSINESS ENTERPRISES LABOR SURPLUS AREA FIRMS FORMS.pdf |
| Disclosure of Lobbying Activities.pdf |
| Unique Entity ID (SAM).pdf |
| Name: |
| Title#1: |
| Date#1: |
| Contractor under: |
| FIRM NAME: |
| Name_2: |
| Title_2: |
| Date_2: |
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