Exhibit A _ Certification Form.docx
DOCX document 34 KB Posted
- Solicitation number
- PE-47200-RFQ-2026-000000118
- Issued by
- Douglas County, Georgia
About this file
This is a Certification Form for the J-462 Renovation project for the Criminal Justice Learning Lab and Public Safety at Albany State University in Albany, Georgia, under the Board of Regents of the University System of Georgia. The form requires the proposer's authorized representative to certify that they have read and understand all proposal materials and that the information provided is complete and truthful. The certification covers representations regarding the proposer's legal standing, including confirmation that neither the proposer nor principal employees have been convicted of crimes of moral turpitude or felony offenses within the preceding five years, nor have had professional licenses suspended or revoked.
The form establishes the proposer's authorization for the Board of Regents to verify all submitted information through appropriate means and to contact any individuals or entities named in the Statement of Qualifications. Proposers must acknowledge that material false statements or omissions in the proposal may result in suspension or debarment from future state contracts, denial or rescission of any awarded contract, and potential criminal prosecution under Georgia and federal law, including O.C.G.A. 16-10-20, 18 U.S.C. § 1001, and 18 U.S.C. § 1341. The certification must be sworn before a notary public and signed by an authorized representative of the firm.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Exhibit D _ DP Fee Proposal.doc | DOC document | |
| Exhibit G _ 179D Allocation Agreement.doc | DOC document | |
| Exhibit F _ Proposers Disclosure Statement.doc | DOC document | |
| Egnyte Upload Instructions.pdf | ||
| Exhibit E _ Contractor Affidavit.docx | DOCX document | |
| J_462 ALSU CJLL _ PS Reno DP RFQ.pdf | ||
| Exhibit B _ Certificate of Minority Form.docx | DOCX document | |
| Exhibit C _ Project Team Composition Form.docx | DOCX document | |
| J_462 CJLL PS DP RFQ _ ADDENDUM 1.pdf |
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Text version
Exhibit A J-462 Renovation for the Criminal Justice Learning Lab and Public Safety Albany State University, Albany, 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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