Exhibit A _ Certification Form.docx
DOCX document 34 KB Posted
- Attached to
- DSC_J-472-DB - Utilities Upgrades, Phase 1
- Solicitation number
- PE-47200-RFQ-2027-000000148
- Issued by
- Ware County, Georgia
About this file
This is a Certification Form for a Design-Build Services project at Dalton State College in Dalton, Georgia, specifically for Project No. J-472-DB, Utilities Upgrades, Phase 1. The form requires the authorized representative of the proposing firm to certify under oath that they have read and fully understand the attached proposal and all enclosures and exhibits. The certifying official must attest that all information provided in response to the request for proposals is complete, accurate, and truthful.
The certification form establishes attestations regarding the proposer's qualifications and history, requiring the signer to verify that neither the proposer nor any principal employee has been convicted of any crime of moral turpitude or felony offense within the preceding five years, nor has had their professional license suspended, revoked, or subjected to disciplinary proceedings. Additionally, the proposer must certify that it has not been suspended or debarred from contracting with any federal, state, or local government agency during the same period and is not currently under consideration for such suspension or debarment. The form further requires certification that the proposer has not defaulted on any government contract within five years and is not under notice of intent to default. The form authorizes the Board of Regents to verify all information provided and acknowledges that material false statements or omissions may result in suspension or debarment from future contracts and criminal prosecution under Georgia law and federal statutes. The document requires notarization, with the notary public providing their seal and commission expiration date.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Exhibit C _ DB Fee Proposal.docx | DOCX document | |
| Exhibit G _ Proposer_s Disclosure Statement.doc | DOC document | |
| DSC J_472_DB RFQ_RFP.pdf | ||
| Egnyte Upload Instructions.pdf | ||
| Exhibit F _ Project Cost Matrix.xlsx | XLSX spreadsheet | |
| Exhibit D _ Precon Cost and Expenses.xlsx | XLSX spreadsheet | |
| Exhibit E _ General Conditions Breakdown.xlsx | XLSX spreadsheet | |
| Exhibit B _ Contractor Affidavit.docx | DOCX document |
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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: _________________
Dalton State College J-472 Utilities Upgrades Phase 1 DB RFQ/RFP
File details come from the government source that posted it. Updated .