Exhibit W Debarment Suspension.pdf
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- Solicitation number
- S-R33123-00018104
- Issued by
- Wasco County, Oregon
About this file
This is a Debarment and Suspension Certification exhibit for RFP No. 2026004, issued by the Northern Wasco County People's Utility District in Oregon for Fiber to the Premises (FTTP) Fiber Optic Construction Services. The certification requires all offerors to verify that neither they nor any of their principals are debarred, suspended, or otherwise ineligible to submit bids or proposals from any federal, state, or local entity. Offerors must certify compliance across six criteria, including freedom from debarment, absence of criminal convictions related to public contracts within the preceding five years, freedom from current criminal charges, absence of judgments arising from public or private contract performance, absence of pending litigation related to contract performance, and no prior termination of public contracts for performance-related reasons. For joint ventures, each participant must execute the certification. All proposals must be signed by an authorized representative with no alterations or erasures permitted without the representative's initials in ink. Offerors unable to certify to any statement must attach an explanation, though such inability does not necessarily preclude contract award.
Offerors must notify the District's representative within 30 days of any changes to the information provided on the certification form. This exhibit does not contain specific pricing terms, set-asides, funding information, or contract term details, as it serves solely as a compliance certification requirement for proposal submission in the FTTP construction procurement.
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Text version
Fiber to the Premises (FTTP) - Fiber Optic Construction Services RFP No.: 2026004
EXHIBIT W
RFP No. 2026004
CERTIFICATION REGARDING DEBARMENT, SUSPENSION
The Offeror certifies to the best of its knowledge and belief that neither it nor any of its principals:
1. Are presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from submitting bids or proposals by any federal, state or local entity, department or agency;
2. Have within a five-year period preceding the date of this certification been convicted of fraud or any other criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) contract, embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property;
3. Are presently indicted for or otherwise criminally charged with commission of any of the offenses enumerated in item number 2 of this certification;
4. Have, within a five-year period preceding the date of this certification had a judgment entered against contractor or its principals arising out of the performance of a public or private contract;
5. Have pending in any state or federal court any litigation in which there is a claim against contractor or any of its principals arising out of the performance of a public or private contract; and
6. Have within a five-year period preceding the date of this certification had one or more public contracts (federal, state, or local) terminated for any reason related to contract performance.
Where Offeror is unable to certify to any of the statements in this certification, Offeror shall attach an explanation to their offer. The inability to certify to all of the statements may not necessarily preclude Offeror from award of a contract under this procurement.
IF THE PROPOSAL IS MADE BY A JOINT VENTURE, IT SHALL BE EXECUTED
BY EACH PARTICIPANT OF THE JOINT VENTURE.
THIS OFFER SHALL BE SIGNED BY AN AUTHORIZED REPRESENTATIVE OF
THE PROPOSER; ANY ALTERATIONS OR ERASURES TO THE OFFER SHALL BE
INITIALED IN INK BY THE UNDERSIGNED AUTHORIZED REPRESENTATIVE.
SIGNATURE OF PROPOSER'S DULY AUTHORIZED REPRESENTATIVE FOR ALL
Fiber to the Premises (FTTP) - Fiber Optic Construction Services RFP No.: 2026004
SECTIONS:
Authorized Signature:
Print Name:
Title:
Contact Person (Type or Print):
Telephone Number: ( )
Email:
The Offeror will notify the District’s Representative/Contact Person on the cover page of this RFP within 30 days of any change in the information provided on this form.
The Offeror will notify the District’s Representative/Contact Person on the cover page of this RFP within 30 days of any change in the information provided on this form.
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