Exhibit A_ Certification Form.docx
DOCX document 34 KB Posted
- Attached to
- SGSC, J-476-DP Library Renovation
- Solicitation number
- PE-47200-RFQ-2027-000000157
- Issued by
- Columbia County, Georgia
About this file
This is a Certification Form for Design Professional Services required by South Georgia State College (SGSC) for Project No. J-476-DP, a Library Renovation project located in Douglas, Georgia. The certification form serves as a compliance document that design professionals must complete and submit as part of their response to the Request for Qualifications (RFQ). The form establishes the qualifications, experience, and certifications of the design firm and key personnel who will be responsible for providing architectural and engineering services for the library renovation project. Respondents are required to certify their professional credentials, licensing status, and relevant project experience prior to proposal submission in accordance with the project requirements and Georgia state regulations.
The certification form requires documentation of professional licenses, insurance coverage, and verification of the firm's ability to perform design services in compliance with applicable codes and standards. Respondents must certify that all team members possess current professional registrations and that the firm maintains appropriate liability insurance. The form ensures that only qualified design professionals capable of managing a renovation project of this scope are considered for award, protecting the institution's interests and project quality standards.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Egnyte Upload Instructions.pdf | ||
| Exhibit C_ Project Team Composition Form.docx | DOCX document | |
| Exhibit G_ 179D Allocation Agreement.doc | DOC document | |
| Exhibit B_ Certificate of Minority Form.docx | DOCX document | |
| Exhibit D_ DP Fee Proposal.doc | DOC document | |
| Exhibit E_ Contractor Affidavit.docx | DOCX document | |
| Exhibit F_ Proposers Disclosure Statement.doc | DOC document | |
| _SGSC J_476_DP RFQ_RFP.pdf |
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Text version
Exhibit A J-476 – Library Renovation South Georgia State College, Douglas, 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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