Exhibit A _ Certification Form.docx
DOCX document 34 KB Posted
- Attached to
- CSU_J-465-DP One Arsenal Place Renovation
- Solicitation number
- PE-47200-RFQ-2026-000000142
- Issued by
- Muscogee County, Columbus City, Georgia
About this file
This is a Certification Form for Design Professional Services submitted to Columbus State University in Columbus, Georgia, for Project No. J-465-DP, One Arsenal Place Renovation. The form serves as the formal certification document that design professionals must complete and submit as part of their response to the Request for Qualifications (RFQ). The certification form requires applicants to verify their qualifications, experience, and eligibility to perform design professional services for the renovation project. Respondents must certify their understanding of project requirements, compliance with applicable regulations, and their capacity to deliver the requested services. The form functions as a binding attestation of the information provided in the proposal submission.
The certification form establishes the baseline requirements and representations that design firms must affirm to be considered for award. By submitting the completed form, respondents acknowledge their review of all project documents, understanding of the scope of work, and commitment to meeting the specified qualifications and standards. The form ensures that only qualified and capable design professionals proceed in the selection process for this renovation project at the State University System of Georgia institution.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Exhibit F _ Proposers Disclosure Statement.doc | DOC document | |
| _J_465 CSU OAPR DP RFQ_RFP.pdf | ||
| Exhibit D _ DP Fee Proposal.doc | DOC document | |
| Exhibit C _ Project Team Composition Form.docx | DOCX document | |
| Exhibit B _ Certificate of Minority Form.docx | DOCX document | |
| Exhibit E _ Contractor Affidavit.docx | DOCX document | |
| Egnyte Upload Instructions_6.pdf | ||
| Exhibit G _ 179D Allocation Agreement.doc | DOC document |
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Text version
Exhibit A Project No. J-465 One Arsenal Place Renovation Columbus State University, Columbus, 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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