Exhibit_A___Certification_Form_1 (1).docx
DOCX document 35 KB Posted
- Solicitation number
- PE-51200-RFQC-2026-000000031
- Issued by
- Richmond County, Georgia
About this file
This is a certification form from the Board of Regents for the State of Georgia related to a request for proposals for Gordon State College's Student Activity & Recreation Center project (PPV-89-1201). The form requires the proposer's authorized representative to certify under oath that they have reviewed the proposal and all attachments, that the information provided is complete and truthful, and that they understand the submission is intended to induce the Board of Regents to award a contract. The certification must be notarized and signed by the proposer's representative.
The form establishes affirmative certifications regarding the proposer's business conduct and legal standing, requiring attestation that neither the proposer nor principal employees have been convicted of crimes of moral turpitude or felonies in the preceding five years, had professional licenses suspended or revoked, or been subjected to disciplinary proceedings. Additionally, proposers must certify they have not been suspended or debarred from contracting with any federal, state, or local government agency, are not under consideration for such suspension or debarment, and have not defaulted on any government contracts in the preceding five years. The form authorizes the Board of Regents to verify all submitted information through any appropriate means and contact any individuals or entities referenced in the Statement of Qualifications. False statements or material omissions in the proposal may result in suspension or debarment from state contracts and may subject the proposer to criminal prosecution under O.C.G.A. 16-10-20, 18 U.S.C. 1001, or 18 U.S.C. 1341.
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Other files
| File | Type | Posted |
|---|---|---|
| Addendum 1.doc | DOC document | |
| NOIA.docx | DOCX document | |
| Exhibit_G___Proposer_s_Disclosure_Statement.doc | DOC document | |
| Addendum 3.doc | DOC document | |
| Exhibit_D___Preconstruction_Cost___Expenses_B.xlsx | XLSX spreadsheet | |
| SIGN IN SHEET.pdf | ||
| J_430 CM RFQ_RFP_.pdf | ||
| Exhibit_B___Contractor_Affidavit (2).docx | DOCX document | |
| Score Sheets.pdf | ||
| Addendum 2.doc | DOC document | |
| Exhibit_E___General_Conditions_Breakdown.xlsx | XLSX spreadsheet | |
| Exhibit_C___CM_GC_Fee_Proposal.docx | DOCX document | |
| Exhibit_F___Project_Cost_Matrix.xlsx | XLSX spreadsheet |
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Text version
Exhibit A
CERTIFICATION FORM
I, _____________________________, being duly sworn, state that I am ______________________(title) of _______________________________(firm) and hereby duly certify that I have read and understand the information presented in the attached proposal and any enclosure and exhibits thereto.
I further certify that to the best of my knowledge the information given in response to the request for proposals is full, complete and truthful.
I further certify that the proposer and any principal employee of the proposer have not, in the immediately preceding five years, been convicted of any crime of moral turpitude or any felony offense, nor has had their professional license suspended, revoked or been subjected to disciplinary proceedings.
I further certify that the proposer has not, in the immediately preceding five years, been suspended or debarred from contracting with any federal, state or local government agency, and further, that the proposer is not now under consideration for suspension or debarment from any such agency.
I further certify that the proposer has not in the immediately preceding five years been defaulted in any federal, state or local government agency contract, and further, that the proposer is not now under any notice of intent to default on any such contract.
I acknowledge, agree and authorize, and certify that the proposer acknowledges, agrees and authorizes, that the Board of Regents may, by means that the Board of Regents deems appropriate, determine the accuracy and truth of the information provided by the proposer and that the Board of Regents or their agents may contact any individual or entity named in the Statement of Qualifications for the purpose of verifying the information supplied therein.
I acknowledge and agree that all of the information contained in the Statement of Qualifications is submitted for the express purpose of inducing the Owner to award a contract.
A material false statement or omission made in conjunction with this proposal is sufficient cause for suspension or debarment from further contracts, or denial of rescission of any contract entered into based upon this proposal thereby precluding the firm from doing business with, or performing work for, the State of Georgia. In addition, such false statement or omission may subject the person and entity making the proposal to criminal prosecution under the laws of the State of Georgia of the United States, including but not limited to O.C.G.A. §16-10-20, 18 U.S.C. §§1001 or 1341.
Signature Sworn and subscribed before me
This _____ day of ________, 20__.
NOTARY PUBLIC
NOTARY SEAL
My Commission Expires: _________________
Gordon State College PPV-89-1201, Student Activity & Rec Ctr., PM RFQ/RFP
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