Form_7.13_-_Debarment_Suspension_and_Other_Responsibility_Matters.pdf
PDF 127 KB Posted
- Solicitation number
- ITB-26-18-CW
- Issued by
- Volusia County, Florida
About this file
This is a Certification Regarding Debarment, Suspension and Other Responsibility Matters form required for submission to the City of Port Orange, Florida in connection with a Mitigation Reconstruction of a Flood Prone Home Project involving the installation of a new elevated manufactured home. The form must be completed and returned by prime contractors as part of their bid submittal for this home rebuild project located in a Port Orange manufactured home park community.
The certification requires prospective contractors to attest that they and their principals are not presently debarred, suspended, proposed for debarment, or excluded from covered transactions by any Federal department or agency. Contractors must also certify that within the preceding three-year period they have not been convicted of or had civil judgments rendered against them for fraud, criminal offenses in connection with public transactions, violations of antitrust statutes, embezzlement, theft, forgery, bribery, falsification or destruction of records, false statements, or receipt of stolen property. Additionally, contractors must confirm they are not presently indicted or criminally or civilly charged with commission of such offenses and have not had public transactions terminated for cause or default within the three-year period. Any prospective contractor unable to certify to these statements must attach an explanation to their proposal. The completed form must include the organization name, bid number or project name, authorized representative name and title, signature, and date.
View the file
Other files
Show all 35
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
FORM 7.13 – CERTIFICATION REGARDING DEBARMENT, SUSPENSION AND OTHER
RESPONSIBILITY MATTERS
Primary Covered Transactions (To be completed by Prime Contractor)
1. The prospective participant certifies to the best of its knowledge and belief that it and its principals:
(a) Are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from covered transactions by and Federal department or agency;
(b) Have not within a three-year period preceding this proposal bee convicted for had a civil judgement rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain or performing a public (Federal, State or 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 statement or receiving stolen property.
(c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph 1. (b) of this certification;
(d) Have not within a three-year period preceding this application/proposal had one or more public transactions (Federal, State or local) terminated for cause or default.
2. Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal.
Organization Name Bid Number or Project Name
Name and Title of Authorized Representative Signature Date
This document must be completed and returned with your Submittal
File details come from the government source that posted it. Updated .