Exhibit A _ Certification Form.docx
DOCX document 34 KB Posted
- Attached to
- UNG, J-466-DP - Strickland Hall Renovation
- Solicitation number
- PE-47200-RFQ-2027-000000145
- Issued by
- Hall County, Georgia
About this file
This is a Certification Form for Project No. J-466, Strickland Hall Renovation at the University of North Georgia in Oakwood, Georgia, submitted in conjunction with a Request for Proposals (RFP) for Design Professional Services. The form requires the authorized representative of a responding firm to certify that they have read and understood the proposal materials and that all information provided is full, complete, and truthful. The certification process is standard for state procurement activities managed through the Board of Regents of the University System of Georgia.
The certification form requires the proposer to attest to several compliance conditions, including that neither the firm nor its principal employees have been convicted of crimes of moral turpitude or felonies, had professional licenses suspended or revoked, or been subjected to disciplinary proceedings within the preceding five years. Additionally, proposers must certify they have not been suspended or debarred from contracting with any federal, state, or local government agency and are not under consideration for such suspension or debarment. Proposers must also confirm they have not defaulted on any government contract and are not under notice of intent to default. The form authorizes the Board of Regents to verify the accuracy of submitted information by contacting individuals and entities named in the Statement of Qualifications. False statements or material omissions may result in suspension or debarment from future state contracts and may subject the person and entity to 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. The form must be notarized before submission.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Exhibit D _ DP Fee Proposal.doc | DOC document | |
| Exhibit F _ Proposers Disclosure Statement.doc | DOC document | |
| Egnyte Upload Instructions.pdf | ||
| Exhibit E _ Contractor Affidavit.docx | DOCX document | |
| Exhibit B _ Certificate of Minority Form.docx | DOCX document | |
| Exhibit C _ Project Team Composition Form.docx | DOCX document | |
| Exhibit G _ 179D Allocation Agreement.doc | DOC document | |
| _J_466 UNG Strickland DP RFQ.pdf |
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Text version
Exhibit A Project No. J-466 Strickland Hall Renovation University of North Georgia, Oakwood, 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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