EXHIBIT 17 - CERTIFICATION OF PROSPECTIVE CONTRACTOR AND LOWER TIER PARTICIPANT REGARDING D.pdf

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Attached to
SHOP TOWELS
Solicitation number
CY133460
Issued by
California

About this file

This is an Exhibit 17 certification form from the Los Angeles County Metropolitan Transportation Authority (LACMTA) that establishes debarment, suspension, ineligibility, and voluntary exclusion requirements for prospective contractors and lower-tier participants on covered transactions exceeding $25,000 in contract value. The certification process applies to both prime bidders/proposers and subcontractors or suppliers. Bidders must certify that they and their principals are not debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency. Additionally, bidders must attest that within the three-year period preceding the proposal, they have not been convicted of fraud, criminal offenses related to public transactions, antitrust violations, embezzlement, theft, forgery, bribery, falsification of records, or had any public transactions terminated for cause or default. Bidders unable to provide full certification must submit written explanations detailing which statements can be certified and which cannot, understanding that failure to furnish either a certification or explanation will result in disqualification from contract participation.

Prime contractors are required to ensure that all subcontractors and lower-tier participants submit the corresponding lower-tier certification form, and they must incorporate these requirements without modification into all lower-tier solicitations and transactions. LACMTA reserves the right to terminate contracts for cause or default if a contractor knowingly renders an erroneous certification or enters into lower-tier transactions with ineligible parties. The regulations are governed by 2 CFR Part 180 and 2 CFR Part 1200, with references to the System for Award Management (SAM) website for verification purposes. Contractors must provide immediate written notice to LACMTA if circumstances change or if any certification becomes erroneous after submission.

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BIDDER/PROPOSER: ______________________

EXHIBIT 17

CERTIFICATION OF PROSPECTIVE CONTRACTOR REGARDING DEBARMENT,

SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION

PRIMARY COVERED TRANSACTIONS MUST BE COMPLETED BY BIDDER/PROPOSER

FOR CONTRACT VALUE OVER $25,000

Choose one of the following alternatives by checking the appropriate box:

The Bidder/Proposer, , 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 or 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 (2) of this certification; and

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

OR

The Bidder/Proposer is unable to certify to all of the statements in this certification, and attaches its explanation to this certification. (In explanation, certify to those statements that can be certified to and explain those that cannot.)

The Bidder/Proposer certifies or affirms the truthfulness and accuracy of the contents of the statements submitted on or with this certification and understands that the provisions of Title 31 USC § 3801, et seq. are applicable thereto.

Executed on , 20 , at , (Date) (City) (State)

Typewritten or Printed Name Signature of Authorized Official Title

BIDDER/PROPOSER: _______________________

SUBCONTRACTOR: _______________________

CERTIFICATION OF PROSPECTIVE LOWER TIER PARTICIPANT REGARDING

DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION

LOWER TIER COVERED TRANSACTIONS MUST BE COMPLETED BY PROSPECTIVE

LOWER TIER PARTICIPANT (SUBCONTRACTOR OR SUPPLIER FOR CONTRACT VALUE

OVER $25,000)

Choose one of the following alternatives by checking the appropriate box:

The prospective lower tier participant ______________________________ certifies by submission of its lower tier bid or proposal to the best of its knowledge and belief, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency.

OR

The prospective lower tier participant ____________________________is unable to certify that neither it nor its principals is not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded and attaches its explanation to this certification.

The prospective lower tier participant certifies or affirms the truthfulness and accuracy of the contents of the statements submitted on or with this certification and understands that the provisions of Title 31 USC § 3801, et seq. are applicable thereto.

Executed on , 20 , at , (Date) (City) (State)

Typewritten or Printed Name Signature of Authorized Official Title

CONTRACTOR DEBARMENT, SUSPENSION, INELIGIBILITY AND VOLUNTARY

EXCLUSION

Pursuant to 2 CFR Part 1200 and 2 CFR Part 180, to confirm the eligibility of the Bidder/Proposer or any covered Subcontractor, Bidder/Proposer shall complete and submit with the bid/proposal the Certificate entitled “Certification of Prospective Contractor Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion” and comply with subsection B below related to each Lower Tier covered transaction.

A. Instructions for Bidder/Proposers Certification - Primary Covered Transactions

1. In addition to signing and submitting this bid/proposal, the Bidder/Proposer (also referred to as “prospective primary participant”) shall also provide the Certificate entitled Certification of Potential Contractor Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Primary Covered Transaction.

2. The inability of a person to provide the subject certification will not necessarily result in denial of participation in this Contract (also referred to as “primary covered transaction” or “covered transaction”). The Bidder/Proposer shall submit an explanation of why it cannot provide the subject certification. The certification or explanation will be considered in whether or not to enter into this Contract. Failure of the Bidder/Proposer to furnish a certification or an explanation shall disqualify the Bidder/Proposer from participation of this Contract.

3. This certification is a material representation of fact upon which LACMTA will rely when LACMTA determines whether to enter into this Contract. If it is later determined that the Bidder/Proposer knowingly rendered an erroneous certification, LACMTA may terminate this Contract for cause or default in addition to other remedies available to LACMTA.

4. The Bidder/Proposer shall provide immediate written notice to LACMTA if at any time the Bidder/Proposer learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.

5. The terms "covered transaction" (or as used herein “Contract”), "debarred", "suspended", "ineligible", "lower tier covered transaction" (or as used herein “Subcontract”), "participant" (or as used herein “Bidder/Proposer”), "person", "primary covered transaction" (or as used herein “Contract” or “Prime Contract”), "principal", "bid/proposal" and "voluntarily excluded", as used in this Section, have the meanings set out in 2 CFR Part 180.

6. The Bidder/Proposer agrees by submitting this bid/proposal that, should the Contract be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is proposed for debarment under 48 CFR Part 9, subpart 9.4, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by LACMTA.

7. The Bidder/Proposer further agrees by submitting this bid/proposal that it will include subsection B of this section and the certification titled “Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered

Transaction,” provided by LACMTA in the Bid/Proposal Forms without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.

8. The Bidder/Proposer may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not proposed for debarment under 48 CFR Part 9, subpart 9.4, debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. The Bidder/Proposer may decide the methods and frequency by which it determines the eligibility of its principals.

The Bidder/Proposer may, but is not required to, check the “System for Award Management (SAM) website.”

9. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this Section. The knowledge and information of the Bidder/Proposer is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

10. Except for transactions authorized under paragraph 6 of this subsection, if a Bidder/Proposer knowingly enters into a lower tier covered transaction with a person who is proposed for debarment under 48 CFR Part 9, subpart 9.4, suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to LACMTA, LACMTA may terminate this transaction for cause or default.

B. Instructions for Prime to Require Sub-contractors’ Certification - Lower Tier Covered Transactions

1. By signing and submitting its lower tier bid/proposal, the prospective lower tier participant shall provide the certification in the Bid/Proposal Form entitled Certification of Prospective Lower Tier Participant Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transactions.

2. The certification in this subsection is a material representation of fact upon which LACMTA will rely when LACMTA enters into the Contract. If it is later determined that the prospective lower tier participant knowingly rendered an erroneous certification, in addition to other remedies available to LACMTA, LACMTA may pursue available remedies, including subcontractor replacement, suspension and/or debarment.

3. The prospective lower tier participant shall provide immediate written notice to the Bidder/Proposer if at any time the prospective lower tier participant learns that its certification was erroneous when submitted or had become erroneous by reason of changed circumstances.

4. The terms "covered transaction" (or as used herein “Contract”), "debarred", "suspended", "ineligible", "lower tier covered transaction" (or as used herein “Subcontract,”), “participant” (or as used herein “Bidder/Proposer”), "person", "primary covered transaction" (or as used herein “Contract” or “Prime Contract”), "principal", "bid/proposal" and "voluntarily excluded", as used in this Section, have the meaning set out in2 CFR Part 180.

5. The prospective lower tier participant agrees by submitting its bid/proposal that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is proposed for debarment under 48 CFR Part 9, subpart 9.4, debarred, suspended, declared ineligible, or voluntarily excluded from participation in this Contract, unless authorized by LACMTA.

6. The prospective lower tier participant further agrees by submitting its bid/proposal that it will include this subsection B and the Certification (in the Bid/Proposal Forms) titled “Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion - Lower Tier Covered Transaction,” without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.

7. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not proposed for debarment under 48 CFR Part 9, subpart 9.4, debarred, suspended, ineligible, or voluntarily excluded from covered transactions, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the System for Award Management website.

8. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this section. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

9. Except for transactions authorized under paragraph 5 of this subsection, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is proposed for debarment under 48 CFR Part 9, subpart 9.4, suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to LACMTA, LACMTA may pursue available remedies, including subcontractor replacement, suspension and/or debarment.

Date:
City:
State:
Typewritten or Printed Name:
Title:
Date_2:
City_2:
State_2:
Typewritten or Printed Name_2:
Title_2:
Bidder/Proposer:
Bidder/Proposer Company Name:
Name of participant:
Name of participant2:
certifies1: Off
unable to certify1: Off
SUBCONTRACTOR:
unable to certify2: Off
certifies2: Off
year:
year2:

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