Non-Debarment Certification.pdf
PDF 72 KB Posted
- Attached to
- IT Managed Services
- Solicitation number
- BD-26-2123-AVC01-AVCMB-127722
- Issued by
- Massachusetts
About this file
This is a Non-Debarment Certification form required by the Assabet Valley Collaborative in Massachusetts for the IT Managed Services procurement. The document serves as a compliance attestation wherein vendors must certify under penalty of perjury that neither they nor their principals, officers, employees, or subcontractors are currently debarred, suspended, proposed for debarment, or declared ineligible by any federal, state, or local government entity. Vendors must further confirm that they and their subcontractors have not been subject to such actions within the preceding three-year period, with any exceptions requiring full disclosure on the form.
The certification establishes an ongoing obligation requiring vendors to promptly notify the issuing entity of any debarment, suspension, or ineligibility that occurs during the procurement process or contract term. The form requires completion with the procurement name, bid number, contract term, and vendor identification information, followed by an authorized signature from an individual with binding authority for the vendor, along with printed name, title, and date. All subcontractors must similarly comply with the non-debarment requirements as a condition of participation in this procurement.
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Text version
NON-DEBARMENT CERTIFICATION
Procurement Name: _____________________COMMBUYS Bid #:___________________________
Contract Term: _______________________Vendor Name: ________________________________
The undersigned, on behalf of the Vendor identified above, hereby certifies under the pains and penalties of perjury that:
No Debarment or Suspension The Vendor, its principals, officers, employees, and subcontractors:
○ Are not currently debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any federal, state, or local government entity;
and
○ Have not been subject to any such actions within the past three (3) years, except as disclosed below
Disclosure of Exceptions (if applicable) The Vendor must disclose any debarment, suspension, or ineligibility actions:
Disclosure (if applicable):
Ongoing Obligation The Vendor agrees to promptly notify the issuing entity if, at any time during the procurement process or contract term, it becomes debarred, suspended, or otherwise ineligible..
Subcontractors The Vendor certifies that all subcontractors are also not debarred or suspended and will comply with this requirement.
Authorized Signature
I certify that I am authorized to bind the Vendor and that the information provided above is true and complete.
Signature: ____________________________Printed Name: _________________________________
Title: _________________________________ Date: _______________________________________
| NON-DEBARMENT CERTIFICATION |
| Authorized Signature |
File details come from the government source that posted it. Updated .