Exhibit A _ Certification Form.docx
DOCX document 34 KB Posted
- Solicitation number
- PE-47200-RFQ-2026-000000123
- Issued by
- Candler County, Georgia
About this file
This is a certification form for a proposal submission related to the J-463 TLC Lecture Hall Renovation and Systems Renewal project at the University of West Georgia in Carrollton, Georgia, administered by the Board of Regents. The certification form requires the proposer's authorized representative to verify that the proposal information is complete and truthful, and to certify compliance with legal and regulatory requirements. The form must be notarized and submitted as part of the proposal response.
The certification requires proposers to attest that they and their principal employees have not been convicted of crimes of moral turpitude or felonies within the preceding five years, have not had professional licenses suspended or revoked, and have not been suspended or debarred from contracting with any federal, state, or local government agency. Additionally, proposers must certify they have not defaulted on any government contracts within the past five years. Proposers authorize the Board of Regents to verify the accuracy of submitted information and acknowledge that material false statements or omissions may result in suspension or debarment from future state contracts and potential criminal prosecution under Georgia law and federal statutes. The form serves as a binding declaration that all information is provided to induce the Board of Regents to award the contract.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Exhibit G _ 179D Allocation Agreement.doc | DOC document | |
| Exhibit C _ Project Team Composition Form.docx | DOCX document | |
| Exhibit E _ Contractor Affidavit.docx | DOCX document | |
| _J_463_TLC Reno _ Renewal_DP_RFQ.pdf | ||
| Exhibit B _ Certificate of Minority Form.docx | DOCX document | |
| Exhibit F _ Proposers Disclosure Statement.doc | DOC document | |
| Exhibit D _ DP Fee Proposal.doc | DOC document | |
| Egnyte Upload Instructions.pdf |
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Text version
Exhibit A J-463, TLC Lecture Hall Renovation and Systems Renewal University of West Georgia, Carrollton, 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
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