Exhibit A _ Certification Form.docx
DOCX document 33 KB Posted
- Solicitation number
- PE-54300-RFQC-2026-000000111
- Issued by
- Cobb County, Georgia
About this file
This is a Certification Form associated with a Request for Qualifications (RFQ) issued by the Board of Regents of the University System of Georgia on behalf of Kennesaw State University for Project No. 555-25-341, Sports & Recreation and Athletics Facilities Master Plans. The RFQ solicits statements of qualifications from professional consultant firms interested in providing master planning services for sports, recreation, and athletics facilities at Kennesaw State University's Kennesaw and Marietta, Georgia campuses. Qualified firms determined to be especially qualified through the initial qualification review process may be invited to participate in interviews for the engagement. The RFQ requires complete review of all instructions, and KSU reserves the right to reject any or all submissions and waive technicalities at its discretion. Questions regarding the RFQ or project must be submitted by email to Theresa Neylon, Senior Campus Planner, at tneylon@kennesaw.edu by the deadline specified in the Schedule of Events section.
The Certification Form requires that a duly authorized representative of the proposing firm attest under oath that all proposal information is full, complete, and truthful. The certifying individual must affirm that neither the proposer nor any principal employee has been convicted of crimes of moral turpitude or felonies, had professional licenses suspended or revoked, or been subjected to disciplinary proceedings within the preceding five years. Additionally, the proposer must certify it has not been suspended, debarred, or defaulted on any federal, state, or local government contracts within the past five years and is not currently under consideration for suspension, debarment, or default. The form authorizes the Board of Regents to verify all submitted information by contacting referenced individuals and entities. False statements or material omissions may result in suspension, debarment, contract denial or rescission, and potential criminal prosecution under Georgia and federal law.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Exhibit E _ Contractor Affidavit.docx | DOCX document | |
| H _ KSU Sports and Recreation EPR Report.pdf | ||
| G _ KSU_campus maps.pdf | ||
| Exhibit F _ Proposer_s Disclosure Statement.doc | DOC document | |
| Exhibit B _ Certificate of Insurance and Mino.docx | DOCX document | |
| I _ KSU Transportation Study_2025_10_1.pdf | ||
| Exhibit C _ Project Team Composition.docx | DOCX document | |
| Exhibit D _ Design Professional Fee Proposal .doc | DOC document | |
| I _ KSU Transportation Study_2025_10_2.pdf | ||
| 555_25_341_S_Rec Athletics MP_PC RFQ_RFP.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
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