Form_9.12(b)_–_Debarment,_Suspension.docx.pdf

This is a Debarment, Suspension, Ineligibility and Voluntary Exclusion Certification form submitted by a subcontractor to the City of Port Orange, Florida for a FEMA-funded elevation project (DEM Contract Number 4673-144-R, FEMA Project Number H1331). The form certifies that the subcontractor, its principals, and affiliates are not presently debarred, suspended, proposed for debarment, declared ineligible, voluntarily excluded, or disqualified from participation in this federal transaction by any Federal department or agency. This certification is required as part of compliance for the RFP 26-24-CW Re-Advertisement for the Elevation of Flood Prone Homes project, which involves the elevation of eleven single-family structures in Florida.

The certification form requires the subcontractor to provide its name, authorized representative signature and title, street address, and the date of submission. This document serves as a prerequisite eligibility confirmation necessary for subcontractors seeking to participate in federally-funded construction projects. The form must be completed and submitted as part of the bid package or subcontractor proposal process for any entity wishing to perform work on the elevation project.