Exhibit A _ Certification Form.docx
DOCX document 33 KB Posted
- Solicitation number
- PE-47200-RFQ-2026-000000120
- Issued by
- Fulton County, Georgia
About this file
This is a Certification Form for a Request for Proposals (RFP) issued by the Board of Regents of the State of Georgia for Gordon State College related to project PPV-89-1201, Student Activity & Recreation Center. The form serves as the official certification document that must be executed by an authorized representative of the proposing firm and notarized. The signatory certifies that they have reviewed the complete proposal and its enclosures, and that all information provided is full, complete, and truthful to the best of their knowledge.
The certification requires the proposer to affirm that within the immediately preceding five years, neither the firm nor any principal employee has been convicted of crimes of moral turpitude or felony offenses, had professional licenses suspended or revoked, or been subjected to disciplinary proceedings. The proposer must further certify that it has not been suspended or debarred from contracting with any federal, state, or local government agency, is not currently under consideration for such suspension or debarment, and has not defaulted on any government contract. The form authorizes the Board of Regents to verify the accuracy of all submitted information through appropriate means and to contact references for verification purposes. The document explicitly warns that material false statements or omissions may result in suspension or debarment from future state contracts, denial or rescission of any awarded contract, and potential criminal prosecution under Georgia law and federal statute, including O.C.G.A. 16-10-20 and 18 U.S.C. §§ 1001 and 1341.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Exhibit G _ Proposer_s Disclosure Statement.doc | DOC document | |
| _GSU BR_50_2603 DB RFQ_RFP.pdf | ||
| Exhibit F _ Project Cost Matrix.xlsx | XLSX spreadsheet | |
| Egnyte Upload Instructions.pdf | ||
| Exhibit D _ Precon Cost and Expenses.xlsx | XLSX spreadsheet | |
| Exhibit E _ General Conditions Breakdown.xlsx | XLSX spreadsheet | |
| Exhibit B _ Contractor Affidavit.docx | DOCX document | |
| Exhibit C _ DB Fee Proposal.docx | DOCX document |
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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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