11-ContractorCertificationForm.pdf

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G-Performanced Based
Solicitation number
RFP-200-0950-SE-Macon-GA-Bibb-County
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11-Contractor Certification-0950-SE

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CCC/CSC/MINT Contract Facility Certification of Compliance

RFP: _______________________________________

By my signature below, I certify that: (Enter facility name, address, and telephone number) complies with the most current local, state, and federal laws and regulations (or whichever is most stringent) concerning facility safety, zoning, occupancy, Architectural Barriers Act (or a reasonable accommodation has been made off-site), and air exchange as outlined in the Statement of Work and the Solicitation for the above reference RFP.

Printed Name: ____________________________________________

Printed Title: ____________________________________________

Signature: ____________________________________________

Date: ____________________________________________

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