Exhibit A _ Certification Form.docx
DOCX document 33 KB Posted
- Solicitation number
- PE-50300-RFP-2025-000000172
- Issued by
- Fulton County, Georgia
About this file
This is a certification form (Exhibit A) for a proposal submission to the Board of Regents and Gordon State College for project PPV-89-1201, Student Activity & Recreation Center PM RFQ/RFP. The document requires authorized representatives of proposing firms to certify under oath their understanding of the proposal requirements and verify the truthfulness of information submitted.
The certification requires attestation that neither the firm nor its principals have been convicted of crimes, had licenses revoked, been debarred from government contracting, or defaulted on government contracts in the preceding five years. The form grants the Board of Regents authority to verify submitted information and acknowledges that false statements can result in contract termination, debarment, and potential criminal prosecution under Georgia and U.S. laws. The document must be signed and notarized.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Addendum__1 for release 01_06_2025.pdf | ||
| Exhibit D _ DP Fee Proposal.doc | DOC document | |
| 0251_2025 RFQP_DP_Final.pdf | ||
| Exhibit H _ Sample Form of AIA Contract.pdf | ||
| Exhibit E _ Contractor Affidavit.docx | DOCX document | |
| Exhibit B _ Certificate of Insurance _ Minori.docx | DOCX document | |
| Exhibit C _ Team Composition.docx | DOCX document | |
| Exhibit F _ Proposer_s Disclosure Statement.doc | DOC document | |
| Exhibit G _ Project Schedule.pdf |
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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
File details come from the government source that posted it. Updated .