Exhibit A _ Certification Form.docx
DOCX document 33 KB Posted
- Attached to
- GSU, BR-50-2509-DP, Art and Humanities Building Expansion and Kopleff Recital Hall Entrance
- Solicitation number
- PE-47200-RFQ-2025-000000098
- Issued by
- Fulton County, Georgia
About this file
This document is a Certification Form for a state government procurement opportunity involving the Board of Regents for Gordon State College, specifically for a Student Activity & Recreation Center project (PPV-89-1201). The certification form requires a detailed attestation from a proposing firm's representative, who must swear under oath that their proposal information is complete, truthful, and that the firm meets specific legal and professional standards.
The certification mandates that the proposing firm and its principal employees have not been convicted of moral turpitude or felony offenses in the past five years, have not been suspended or debarred from government contracts, and have not defaulted on previous government contracts. The form authorizes the Board of Regents to verify all submitted information and warns that any material false statement could result in suspension, debarment, contract rescission, and potential criminal prosecution under Georgia and federal laws. The document requires a notarized signature, indicating the formal and legally binding nature of the proposer's declarations.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Exhibit E _ Contractor Affidavit.docx | DOCX document | |
| _GSU BR_50_2509 DP GSU Arts _ Humanities_RFQ.pdf | ||
| Exhibit C _ Project Team Composition Form.docx | DOCX document | |
| Exhibit G _ 179D Allocation Agreement.doc | DOC document | |
| Exhibit F _ Proposers Disclosure Statement.doc | DOC document | |
| Exhibit B _ Certificate of Minority Form.docx | DOCX document | |
| Exhibit D _ DP Fee Proposal.doc | DOC document | |
| Egnyte Upload Instructions.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 .