Exhibit A _ RFQ Certification Form.docx
DOCX document 34 KB Posted
- Attached to
- CSU_J-465-PM - One Arsenal Place Renovation
- Solicitation number
- PE-47200-RFQ-2026-000000134
- Issued by
- Muscogee County, Columbus City, Georgia
About this file
This is a Certification Form (Exhibit A) for a Request for Qualifications (RFQ) submitted to Columbus State University in Columbus, Georgia, for Program Management Services related to Project No. J-465, One Arsenal Place Renovation. The form requires the proposer's authorized representative to certify under oath that they have reviewed the proposal and all enclosures, that the information provided is complete and truthful, and that they are authorized to bind the proposing firm. The form does not specify project quantities, response dates, due dates, site visits, bidder meetings, award dates, or contract terms, as it serves solely as a certification and sworn statement document rather than a comprehensive RFQ announcement.
The certification form requires attestation regarding the proposer's professional qualifications and history, including declarations that neither the proposer nor principal employees have been convicted of crimes of moral turpitude or felonies, had professional licenses suspended or revoked, or faced disciplinary proceedings within the preceding five years. The form further requires certification that the proposer has not been suspended, debarred, or in default on any federal, state, or local government contracts within the same period. The document authorizes the Board of Regents to verify all submitted information and warns that material false statements or omissions may result in suspension, debarment, contract denial or rescission, and potential criminal prosecution under Georgia 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 F _ Proposer_s Disclosure Statement.doc | DOC document | |
| Exhibit D _ PM Fee Proposal Form.xlsx | XLSX spreadsheet | |
| Exhibit B _ Certificate of Minority Form.docx | DOCX document | |
| _J_465 CSU PM RFQ_RFP.pdf | ||
| Exhibit E _ Contractor Affidavit.docx | DOCX document | |
| Egnyte Upload Instructions.pdf | ||
| Exhibit C _ Project Team Composition Form.docx | DOCX document |
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Text version
Exhibit A J-465 One Arsenal Place Renovation Columbus State University, Columbus, 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 ________, 200__.
NOTARY PUBLIC
NOTARY SEAL
My Commission Expires: _________________
Gordon State College PPV-89-1201, Student Activity & Rec Ctr., PM RFQ/RFP
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