Exhibit A _ Certification Form.docx
DOCX document 35 KB Posted
- Attached to
- UNG BR-68-2601-DB Poultry Instructional Center
- Solicitation number
- PE-47200-RFQ-2026-000000121
- Issued by
- Lanier County, Georgia
About this file
This is a Certification Form for a Request for Proposals (RFP) issued by the Board of Regents for Gordon State College related to project PPV-89-1201, Student Activity & Recreation Center. The form serves as a sworn statement requiring the authorized representative of the proposing firm to certify that all information submitted in the proposal is full, complete, and truthful. The signatory must verify that neither the proposer nor any principal employee has been convicted of crimes of moral turpitude or felonies, or had professional licenses suspended or revoked within the preceding five years. Additionally, the proposer must confirm that it has not been suspended or debarred from contracting with any federal, state, or local government agency and is not currently under consideration for such action, nor has it defaulted on any government contract in the previous five years.
The certification form establishes that the Board of Regents reserves the right to verify all information provided through appropriate means and may contact any individuals or entities referenced in the Statement of Qualifications. The form emphasizes that all submitted information is provided expressly to induce the awarding of a contract and that material false statements or omissions constitute grounds for suspension, debarment, or contract denial or rescission. Violators may be precluded from conducting business with or performing work for the State of Georgia and may face criminal prosecution under applicable Georgia and federal statutes, including O.C.G.A. 16-10-20, 18 U.S.C. 1001, and 18 U.S.C. 1341. The form requires notarization and must be executed before a notary public.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| _UNG BR_68_2601_DB RFQ_RFP.pdf | ||
| Exhibit C _ DB Fee Proposal.docx | DOCX document | |
| Exhibit F _ Project Cost Matrix.xlsx | XLSX spreadsheet | |
| Exhibit D _ Precon Cost and Expenses.xlsx | XLSX spreadsheet | |
| Exhibit B _ Contractor Affidavit.docx | DOCX document | |
| Exhibit G _ Proposer_s Disclosure Statement.doc | DOC document | |
| Exhibit E _ General Conditions Breakdown.xlsx | XLSX spreadsheet | |
| 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 .