Exhibit A _ Certification Form.docx
DOCX document 33 KB Posted
- Solicitation number
- PE-50300-RFP-2027-000000320
- Issued by
- Fulton County, Georgia
About this file
This is a Certification Form for a state and local contract opportunity involving the State of Georgia and Gordon State College for Project PPV-89-1201, Student Activity & Recreation Center. The form functions as a sworn certification document that must be completed and notarized by an authorized representative of the proposing firm. The certifier must attest to the accuracy, completeness, and truthfulness of all information contained in the proposal and Statement of Qualifications, and acknowledges that the Board of Regents may verify information provided through any appropriate means, including direct contact with named individuals or entities.
The certification requires the proposer to declare 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, the proposer must certify that it has not been suspended or debarred from contracting with any federal, state, or local government agency and is not currently under consideration for such action. The proposer further certifies no defaults on government contracts have occurred within the preceding five years and that no notice of intent to default is currently pending. Material false statements or omissions in the proposal may result in suspension or debarment from future contracts with the State of Georgia and may subject the person and entity to criminal prosecution under Georgia law or federal statutes including O.C.G.A. 16-10-20, 18 U.S.C. 1001, or 1341.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| _2001_27_ RFQP_CM GLC CoLL Renovation.pdf | ||
| Exhibit C _ CM_GC Fee Proposal.docx | DOCX document | |
| Exhibit E _ General Conditions_Breakdown.xlsx | XLSX spreadsheet | |
| Exhibit G _ Proposer_s Disclosure Statement.doc | DOC document | |
| Exhibit F _ Project Cost Matrix.xlsx | XLSX spreadsheet | |
| Exhibit B _ Contractor Affidavit.docx | DOCX document | |
| Exhibit D _ Preconstruction Cost_Expenses Bre.xlsx | XLSX spreadsheet |
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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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