Exhibit A _ RFQ Certification Form.docx
DOCX document 34 KB Posted
- Attached to
- UNG, J-466-PM Strickland Hall Renovation
- Solicitation number
- PE-47200-RFQ-2026-000000135
- Issued by
- Hall County, Georgia
About this file
This is a certification form for a Request for Qualifications (RFQ) for the J-466 Strickland Hall Renovation project at the University of North Georgia in Oakwood, Georgia, administered by the Board of Regents of the State of Georgia. The form requires the proposer's authorized representative to certify under oath that they have read and understand the attached proposal, enclosures, and exhibits, and that all information provided is complete and truthful.
The certification document mandates that proposers attest to specific legal and compliance requirements, including that neither the proposer nor principal employees have been convicted of crimes of moral turpitude or felony offenses in the preceding five years, nor have had professional licenses suspended or revoked. Proposers must further certify that they have not been suspended or debarred from contracting with any federal, state, or local government agency within the preceding five years and are not currently under consideration for suspension or debarment. Additionally, proposers must confirm they have not defaulted on any government contracts and are not under notice of intent to default. The form authorizes the Board of Regents to verify the accuracy and truthfulness of all submitted information through appropriate means and to contact references for verification. The document emphasizes that material false statements or omissions constitute grounds for suspension, debarment, or contract denial, and may subject the proposer to criminal prosecution under Georgia state law and federal statutes, including O.C.G.A. 16-10-20, 18 U.S.C. 1001, and 18 U.S.C. 1341. The certification must be notarized with the notary's seal and signature affixed.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Exhibit D _ PM Fee Proposal Form.xlsx | XLSX spreadsheet | |
| Exhibit C _ Project Team Composition Form.docx | DOCX document | |
| Exhibit B _ Certificate of Minority Form.docx | DOCX document | |
| Exhibit F _ Proposer_s Disclosure Statement.doc | DOC document | |
| Egnyte Upload Instructions.pdf | ||
| _J_466 UNG PM RFQ_RFP.pdf | ||
| Exhibit E _ Contractor Affidavit.docx | DOCX document |
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Text version
Exhibit A J-466 Strickland Hall Renovation University of North Georgia, Oakwood, 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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