Exhibit A _ Certification Form.docx
DOCX document 34 KB Posted
- Attached to
- UGA, J-459-DP School of Nursing Building
- Solicitation number
- PE-47200-RFQ-2026-000000117
- Issued by
- Clayton County, Georgia
About this file
This is a Certification Form submitted to the University of Georgia for design professional services related to Project No. J-459-DP, the School of Nursing Building located in Athens, Georgia. The form serves as an exhibit to the Request for Qualifications (RFQ) and requires applicants to certify their qualifications, experience, and ability to perform the design professional services for this academic building project. The document outlines the certification requirements that firms must complete and submit as part of their proposal response, ensuring compliance with the university's selection criteria and project specifications.
The certification form includes mandatory declarations regarding the firm's professional licensure, insurance coverage, references, and past project experience relevant to institutional and healthcare facility design. Respondents must attest to their understanding of the project scope, their capability to meet the university's requirements, and their commitment to the project timeline and deliverables. The form functions as a qualifying document that helps the University of Georgia evaluate the competency and credibility of design professional firms seeking to be selected for this significant institutional construction project.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Exhibit C _ Project Team Composition Form.docx | DOCX document | |
| J_459 UGA School of Nursing DP RFQ.pdf | ||
| Exhibit G _ 179D Allocation Agreement.doc | DOC document | |
| Exhibit F _ Proposers Disclosure Statement.doc | DOC document | |
| Exhibit E _ Contractor Affidavit.docx | DOCX document | |
| Exhibit D _ DP Fee Proposal.doc | DOC document | |
| Egnyte Upload Instructions.pdf | ||
| Exhibit B _ Certificate of Minority Form.docx | DOCX document |
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Text version
Exhibit A J-459 School of Nursing Building University of Georgia, Athens, Georgia
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 .