EXHIBIT F-1 - PAYMENT CERTIFICATION (CONTINUOUS).pdf
PDF 167 KB Posted
- Attached to
- UPS Battery Replacement Location 64
- Solicitation number
- PS132603(2)
- Issued by
- California
About this file
This is a Payment Certification form for continuous services under a contract with the Los Angeles County Metropolitan Transportation Authority (LACMTA). The certification document serves as a contractual attestation by the contractor that services have been performed in accordance with contract terms and that all subcontractors and suppliers have been paid their proportionate share of previous payments. The contractor certifies that the payment request represents a true and accurate statement of services completed to date and that no amounts are being withheld from subcontractors or suppliers outside the terms of their subcontracts. The certification must be executed and signed by an authorized official of the contracting firm, with the document requiring identification of the firm name, certifying official's name and title, date of execution, and contract number.
The contractor makes several critical certifications regarding eligibility and legal standing, including that neither the contractor nor its principals are currently debarred, suspended, or ineligible for government contracts, nor have they been terminated for cause or default on public transactions within the past three years. Additionally, the contractor certifies that it has not been convicted of fraud, criminal offenses, antitrust violations, embezzlement, theft, forgery, bribery, falsification of records, false statements, or receipt of stolen property in connection with public transactions. The certification explicitly acknowledges the contractor's understanding of liability under both federal and California False Claims Acts, including criminal and civil penalties for knowingly presenting false claims, with the standard of "knowingly" including actual knowledge, deliberate ignorance, or reckless disregard for truthfulness. This certification is explicitly stated as not constituting final acceptance of the contractor's or any subcontractor's performance.
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Text version
A. I hereby certify to the best of my knowledge and belief that:
1. This Payment Certification represents a true and correct statement of the Services performed;
2. The Services completed to date under this Contract are in full accordance with the terms of the Contract Documents;
3. All Subcontractors and/or Suppliers who have performed Services on the project through the closing date of the prior Payment Request have been paid their proportionate share of all previous payments from LACMTA;
4. This Payment Certification does not include any amounts which the Contractor intends to withhold or retain from a Subcontractor or Supplier in accordance with the terms and conditions of the subcontract; and
5. The Contractor and its principals, (i) are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any governmental department or agency (federal, state, or local); (ii) have not in the past three years had one or more public transactions (federal, state, or local) terminated for cause or default; (iii) have not within the past three years been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state, local) transaction or contract under a public transaction, violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; and (iv) are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (federal, state, local) with commission of any of the offenses listed in Section (A)(5)(iii) above.
B. This Payment Certification is not to be construed as final Acceptance of the Contractor's, and any Subcontractor's or Supplier's performance.
C. I understand that it is a violation of both the federal and California False Claims Acts to knowingly present or cause to be presented to LACMTA a false claim for payment or approval. A claim includes a demand or request for money. It is also a violation of the False Claims Acts to knowingly make use of a false Record or statement to get a false claim paid. The term "knowingly" includes either actual knowledge of the information, deliberate ignorance of the truth or falsity of the information, or reckless disregard for the truth or falsity of the information. Proof of specific intent to defraud is not necessary under the False Claims Acts. I understand that the penalties under the Federal False Claims Act and State of California False Claims Act are non-exclusive, and are in addition to any other criminal and/or civil remedies which LACMTA may have either under contract or law.
EXHIBIT F-1 - PAYMENT CERTIFICATION (CONTINUOUS)
I certify under penalty of perjury, under the laws of the State of California, that the foregoing is true and correct
Firm:
Signature:
Name of Certifying Official:
Title:
Date of Execution:
| Firm: |
| Name of Certifying Official: |
| Title: |
| Date of Execution: |
| Contract Number: Contract Number |
| Project Name: Project Name |
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