Exhibit A _ Certification Form.docx
DOCX document 34 KB Posted
- Solicitation number
- PE-47200-RFQ-2027-000000146
- Issued by
- Tattnall County, Georgia
About this file
This is a Certification Form for a project titled "J-477 Renovations for Student Success and Career Services" at Abraham Baldwin Agricultural College in Tifton, Georgia, administered by the Board of Regents. The certification form serves as the official sworn statement by authorized representatives of proposing firms and must be notarized. The form establishes the procedural requirements for bid submission, including verification of proposal completeness and truthfulness by the signatory.
The certification requires proposers to attest that they and their principal employees have not been convicted of crimes of moral turpitude or felonies within the preceding five years, have not had professional licenses suspended or revoked, and have not been suspended or debarred from contracting with federal, state, or local government agencies. Additionally, proposers must certify that they have not defaulted on any government contracts within the preceding five years and are not currently under notice of default or consideration for suspension or debarment. The Board of Regents reserves the right to verify all information submitted and may contact individuals or entities named in the Statement of Qualifications. Material false statements or omissions may result in suspension or debarment from future state contracts and may subject the proposer to criminal prosecution under Georgia state 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 |
|---|---|---|
| Exhibit B _ Certificate of Minority Form.docx | DOCX document | |
| _J_477 ABAC RSSCS DP RFQ_RFP.pdf | ||
| Exhibit F _ Proposers Disclosure Statement.doc | DOC document | |
| Exhibit D _ DP Fee Proposal.doc | DOC document | |
| Exhibit C _ Project Team Composition Form.docx | DOCX document | |
| Exhibit G _ 179D Allocation Agreement.doc | DOC document | |
| Exhibit E _ Contractor Affidavit.docx | DOCX document | |
| Egnyte Upload Instructions.pdf |
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Text version
Exhibit A J-477 Renovations for Student Success and Career Services Abraham Baldwin Agricultural College, Tifton, 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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