Exhibit_A___Certification_Form_1 (1).pdf
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- Solicitation number
- PE-51200-RFQ-2027-000000040
- Issued by
- Richmond County, Atlanta City, Georgia
About this file
This is a Certification Form required by the Board of Regents for the State of Georgia in connection with the Interdisciplinary Research Building Fire Alarm System Replacement project. The certification form serves as a sworn statement by an authorized representative of the proposing firm, affirming the accuracy and completeness of all proposal information submitted in response to the request for proposals. The form requires the signatory to certify compliance with various eligibility and qualification requirements, including confirmation that neither the proposer nor its principal employees have been convicted of crimes of moral turpitude, felonies, or subjected to professional license discipline within the preceding five years. The certification also requires attestation that the proposer has not been suspended, debarred, or defaulted on any federal, state, or local government contracts within the same timeframe and is not currently under consideration for such actions.
The form grants the Board of Regents authority to verify all information provided through any means deemed appropriate and permits contact with individuals or entities named in the Statement of Qualifications. Proposers must acknowledge that submission of false statements or material omissions in the certification constitutes sufficient grounds for suspension or debarment from future state contracts and denial or rescission of any awarded contract. The form further advises that false statements or omissions may result in criminal prosecution under Georgia law, including O.C.G.A. 16-10-20, and federal law, including 18 U.S.C. sections 1001 and 1341. The certification must be notarized and signed by an authorized representative of the firm, with the notary public affixing their seal and providing their commission expiration date.
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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: _________________
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