Exhibit A _ Certification Form.docx
DOCX document 35 KB Posted
- Solicitation number
- PE-47200-RFQ-2026-000000125
- Issued by
- Fulton County, Georgia
About this file
This is a Certification Form for a Request for Proposals (RFP) issued by the Board of Regents of the State of Georgia for Gordon State College's Student Activity & Recreation Center project (PPV-89-1201). The form serves as a sworn statement by an authorized representative of the proposing firm, certifying that the proposal information is complete, accurate, and truthful. The signatory must affirm their title and firm name, acknowledge reading all proposal materials, and verify the authenticity of all submitted information and enclosures.
The certification requires proposers to attest that neither they nor their principal employees have been convicted of crimes of moral turpitude or felonies, had professional licenses suspended or revoked, or faced disciplinary proceedings within the preceding five years. Proposers must also certify that they have not been suspended or debarred from contracting with any federal, state, or local government agency during this period, nor are they currently under consideration for such suspension or debarment. Additionally, proposers must confirm they have not defaulted on any government contracts in the past five years and are not under notice of intent to default. The Board of Regents is authorized to verify all submitted information through any appropriate means and may contact references named in the Statement of Qualifications. Material false statements or omissions in the proposal are grounds for suspension, debarment, or denial of contract rescission and may result in criminal prosecution under Georgia law and federal statutes, including O.C.G.A. 16-10-20, 18 U.S.C. 1001, and 18 U.S.C. 1341.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Egnyte Upload Instructions.pdf | ||
| Exhibit F _ Project Cost Matrix.xlsx | XLSX spreadsheet | |
| Exhibit G _ Proposer_s Disclosure Statement.doc | DOC document | |
| Exhibit C _ DB Fee Proposal.docx | DOCX document | |
| Exhibit B _ Contractor Affidavit.docx | DOCX document | |
| Exhibit D _ Precon Cost and Expenses.xlsx | XLSX spreadsheet | |
| Exhibit E _ General Conditions Breakdown.xlsx | XLSX spreadsheet | |
| _GIT BR_30_2602 DB GTRI 1906_final.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
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