Exhibit A _ Certification Form.docx
DOCX document 34 KB Posted
- Attached to
- UGA_BR-10-2702 DP Oglethorpe House Renovation
- Solicitation number
- PE-47200-RFQ-2027-000000162
- Issued by
- Clayton County, Georgia
About this file
This is a Certification Form for Project No. BR-10-2702, the Oglethorpe House Renovation at the University of Georgia in Athens, Georgia, administered by the Board of Regents. The form serves as a sworn certification that the proposal submitter has read and understands all proposal materials and that the information provided is complete and truthful. The certifier must confirm that neither the proposer nor any principal employees have been convicted of crimes of moral turpitude or felonies, nor have had professional licenses suspended, revoked, or been subject to disciplinary proceedings within the preceding five years.
The certification further requires attestation that the proposer has not been suspended or debarred from contracting with any federal, state, or local government agency within five years and is not currently under consideration for such suspension or debarment. The proposer must also certify that it has not defaulted on any government contract and is not under notice of intent to default. The form authorizes the Board of Regents to verify all information provided through appropriate means and to contact any individuals or entities referenced in the Statement of Qualifications. The document warns that material false statements or omissions constitute grounds for suspension, debarment, or denial and rescission of any awarded contract, and may result in criminal prosecution under state and federal law, including O.C.G.A. 16-10-20, 18 U.S.C. 1001, and 18 U.S.C. 1341. The form requires notarization.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Exhibit C _ Project Team Composition Form.docx | DOCX document | |
| Exhibit G _ 179D Allocation Agreement.doc | DOC document | |
| _UGA_BR_10_2702_DP RFQ_RFP.pdf | ||
| Exhibit F _ Proposers Disclosure Statement.doc | DOC document | |
| Exhibit E _ Contractor Affidavit.docx | DOCX document | |
| Exhibit D _ DP Fee Proposal.doc | DOC document | |
| Egnyte Upload Instructions.pdf | ||
| Exhibit B _ Certificate of Minority Form.docx | DOCX document |
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Text version
Exhibit A Project No. BR-10-2702 Oglethorpe House Renovation University of Georgia, Athens, 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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