Exhibit A _ Certification Form.docx
DOCX document 34 KB Posted
- Solicitation number
- PE-47200-RFQ-2026-000000111
- Issued by
- Cobb County, Georgia
About this file
This is a Certification Form for a construction project at Kennesaw State University in Georgia, issued by the Board of Regents. The document pertains to the Bailey School of Music & Textiles Chastain Pointe Renovations project, identified as BR-90-2601. The certification form serves as a sworn statement to be completed and notarized by an authorized representative of the proposing firm, confirming that the firm has read and understands the proposal requirements and supporting documentation. The form requires the signatory to verify that all information submitted is accurate, complete, and truthful.
The certification form mandates that the proposing firm and its principal employees have not, within the preceding five years, been convicted of crimes of moral turpitude, felony offenses, or experienced suspension, revocation, or disciplinary action regarding professional licenses. Additionally, the proposer must certify that it has not been suspended or debarred from contracting with federal, state, or local government agencies and is not currently under consideration for such action. The proposer must also confirm no defaults on government contracts and no pending notices of intent to default. The form explicitly authorizes the Board of Regents to verify the accuracy of submitted information through any means deemed appropriate, including direct contact with referenced individuals or entities. False statements or material omissions in the proposal may result in suspension or debarment from future state contracts and may subject the proposer to criminal prosecution under Georgia law and federal statutes.
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Other files
| File | Type | Posted |
|---|---|---|
| KSU_BR_90_2601 DP_NOIA.pdf | ||
| Exhibit B _ Certificate of Minority Form.docx | DOCX document | |
| Exhibit G _ 179D Allocation Agreement.doc | DOC document | |
| KSU BR_90_2601 DP shortlist_gpr.pdf | ||
| _BR_90_2601_BSOM_Textiles_DP RFQ_RFP.pdf | ||
| Egnyte Upload Instructions.pdf | ||
| Exhibit E _ Contractor Affidavit.docx | DOCX document | |
| Exhibit C _ Project Team Composition Form.docx | DOCX document | |
| Exhibit D _ DP Fee Proposal.doc | DOC document | |
| BR_90_2601 BSOMT DP RFQ _ ADDENDUM 02.pdf | ||
| Exhibit F _ Proposers Disclosure Statement.doc | DOC document | |
| BR_90_2601 BSOMT DP RFQ _ ADDENDUM 01.pdf |
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Text version
Exhibit A
BR-90-2601, Bailey School of Music & Textiles Chastain Pointe Renovations Kennesaw State University, Kennesaw, 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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