Exhibit A _ Certification Form.docx
DOCX document 35 KB Posted
- Solicitation number
- PE-47200-RFQ-2026-000000110
- Issued by
- Barrow County, Georgia
About this file
This is a certification form required for a proposal submission to the Board of Regents for the State of Georgia, specifically related to Gordon State College's Student Activity & Recreation Center project (PPV-89-1201). The form serves as a sworn statement by the proposer or an authorized representative confirming the accuracy and completeness of the submitted proposal and all supporting documentation. The proposer must certify that they have thoroughly reviewed all proposal materials and that the information provided is full, complete, and truthful.
The certification form requires the proposer to attest that neither the firm nor its principal employees have, within the preceding five years, been convicted of crimes of moral turpitude or felonies, had professional licenses suspended or revoked, or faced disciplinary proceedings. Additionally, the proposer must verify that the firm has not been suspended or debarred from contracting with any federal, state, or local government agency and is not currently under consideration for such suspension or debarment. The proposer must also confirm no defaults on any government contracts and no pending notices of intent to default. The form authorizes the Board of Regents to verify all information submitted through any appropriate means and permits contact with named references. 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 or federal statutes, including O.C.G.A. 16-10-20, 18 U.S.C. 1001, or 18 U.S.C. 1341. The certification must be notarized and signed by an authorized representative of the proposing firm.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| GCSU BR_65_2601 DB RFQ_RFP.pdf | ||
| Exhibit E _ General Conditions Breakdown.xlsx | XLSX spreadsheet | |
| Exhibit F _ Project Cost Matrix.xlsx | XLSX spreadsheet | |
| Exhibit C _ DB Fee Proposal.docx | DOCX document | |
| Exhibit D _ Precon Cost and Expenses.xlsx | XLSX spreadsheet | |
| Egnyte Upload Instructions.pdf | ||
| BR_65_2601 Addendum No_ 2.pdf | ||
| GCSU BR_65_2601 Addendum No_ 1.pdf | ||
| GCSU_BR_65_2601 DB_NOIA.pdf | ||
| Exhibit B _ Contractor Affidavit.docx | DOCX document | |
| GCSU BR_65_2601 DB shortlist_gpr.pdf | ||
| Exhibit G _ Proposer_s Disclosure Statement.doc | DOC document | |
| BR_65_2601 DB AWARD.docx | DOCX document |
Show all 13
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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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