F-01788 Certification Regarding Debarment and Suspension.docx

This is a certification document from the Wisconsin Department of Health Services, Division of Enterprise Services, related to a Preadmission Screening and Resident Reviews (PASRR) Level II Screens contract opportunity. The document requires vendors to certify their compliance with Federal Executive Order 12549 regarding debarment and suspension. The certification mandates that all contractors receiving individual awards using federal funds and all subrecipients confirm that their organization and principals are not debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal department or agency from conducting business with the Federal Government. The contract opportunity involves soliciting vendors to perform federally required PASRR Level II screens to evaluate prospective and current nursing home residents in Wisconsin on behalf of the Department of Health Services, specifically focusing on residents with serious mental illness or intellectual and developmental disabilities.

Vendors must sign the F-01788 certification form, acknowledging that neither they nor their principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in the transaction by any federal department or agency. The form requires the authorized signatory to provide the vendor name, DUNS number if applicable, and date signed. Failure to comply with certification requirements or attempts to edit the provided language may result in bid disqualification. Information regarding debarment status can be verified through www.sam.gov and the Federal Acquisition Regulation (FAR) section 52.209-6 available at https://acquisition.gov/far/index.html.