Debarment_Form.pdf
PDF 160 KB Posted
- Attached to
- Construction Manager at Risk (CMAR) services for the Santa Rosa County Sheriff's Administrative Complex
- Solicitation number
- 26-053
- Issued by
- Santa Rosa County, Mount Carmel CDP, Florida
About this file
This is a Debarment Certification Form issued by the Santa Rosa County Procurement Department for RFQ 26-053, Construction Manager at Risk (CMAR) services for the Santa Rosa County Sheriff's Administrative Complex. The form requires prospective primary participants to certify their eligibility and responsibility status prior to proposal submission. Proposals are due October 6, 2026 at 10:00 a.m., with questions due by September 29, 2026 at 12:00 p.m. The form must be completed and signed by an authorized representative of the firm submitting a proposal for the CMAR services contract.
The debarment certification requires bidders to attest that they and their principals are not currently debarred, suspended, or excluded from covered transactions by any Federal department or agency; have not been convicted of fraud or related criminal offenses within three years; are not presently indicted for such offenses; and have not had public transactions terminated for cause or default within three years. Respondents unable to certify to any statement must attach an explanation to their proposal. This certification is mandatory for all participants given the project's federal funding, which triggers compliance with 2 CFR 200 and requires registration with the Federal System of Award Management (SAM) at contract award.
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Text version
SANTA ROSA COUNTY
PROCUREMENT DEPARTMENT
6495 Caroline Street, Suite L| Milton, Florida 32570 850-983-1870 procurement@santarosa.fl.gov
Office: 850.983.1870 | Fax: 850.983.1860 | www.santarosa.fl.gov
DEBARMENT FORM
Certification Regarding Debarment, Suspension, And Other Responsibility Matters
1. The prospective primary participant certifies to the best of its knowledge and belief, that it and its principals:
a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency;
b. Have not within a three-year period preceding this proposal 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;
c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State, or Local) with commission of any of the offenses enumerated in paragraph (1)(b) of this certification; and
d. Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State, or Local) terminated for cause or default.
2. Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal.
Name: ____________________________________ Title: ___________________________
Signature: _________________________________
Firm: ____________________________________
Street Address: ______________________________
City: ______________________________________
State: __________ Zip Code: __________________
Solicitation Name ___________________________________# XX-XXX _______________
File details come from the government source that posted it. Updated .