SMMA Certification Form Exhibit D.pdf
PDF 98 KB Posted
- Solicitation number
- PE-91100-RFP-2027-000000003
- Issued by
- Dekalb County, Georgia
About this file
This certification form is required documentation for proposals submitted to the Stone Mountain Memorial Association (SMMA) in Georgia for cleaning and preservation services of the Confederate Memorial Carving on Stone Mountain's north face. The SMMA is soliciting qualified firms to provide specialized cleaning and preservation work on this historic resource, with site visits available between July 24 and August 7, 2026. Prospective bidders must schedule in-person evaluations of the Carving at least 48 hours in advance by contacting procurement@stonemountainpark.org. The work must be performed with exceptional care to ensure the cleaning methodology does not damage, abrade, or degrade the Carving in any way.
The certification form requires the proposer's authorized representative to affirm under oath that all proposal information is complete, truthful, and accurate. Proposers must certify they have not been convicted of crimes of moral turpitude or felonies within the preceding five years, have not had professional licenses suspended or revoked, and have not been suspended, debarred, or in default on any federal, state, or local government contracts. The form authorizes SMMA to verify all submitted information and contact references as needed. Proposers acknowledge that material false statements or omissions may result in suspension, debarment, contract denial or rescission, and potential criminal prosecution under Georgia and federal law, including O.C.G.A. 16-10-20, 18 U.S.C. 1001, and 18 U.S.C. 1341.
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Other files
| File | Type | Posted |
|---|---|---|
| State Contract _ SMMA.pdf | ||
| SMMA Carving RFP.docx | DOCX document | |
| SMMA Exhibit E E_verify.pdf |
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Text version
Exhibit D Stone Mountain Memorial Association
Cleaning and Preservation of Stone Mountain Memorial Carving
CERTIFICATION FORM
I, _____________________________, being duly sworn, state that I am ______________________(title) of _______________________________(firm) and hereby duly certify that I have read and understand the information presented in the attached proposal and any enclosure and exhibits thereto.
I further certify that to the best of my knowledge the information given in response to the request for proposals is full, complete and truthful.
I further certify that the proposer and any principal employee of the proposer have not, in the immediately preceding five years, been convicted of any crime of moral turpitude or any felony offense, nor has had their professional license suspended, revoked or been subjected to disciplinary proceedings.
I further certify that the proposer has not, in the immediately preceding five years, been suspended or debarred from contracting with any federal, state or local government agency, and further, that the proposer is not now under consideration for suspension or debarment from any such agency.
I further certify that the proposer has not in the immediately preceding five years been defaulted in any federal, state or local government agency contract, and further, that the proposer is not now under any notice of intent to default on any such contract.
I acknowledge, agree and authorize, and certify that the proposer acknowledges, agrees and authorizes, that the Stone Mountain Memorial Association may, by means that the Stone Mountain Memorial Association deems appropriate, determine the accuracy and truth of the information provided by the proposer and that the Stone Mountain Memorial Association or their agent(s) may contact any individual or entity named in the Request for Proposal for the purpose of verifying the information supplied therein.
I acknowledge and agree that all of the information contained in the Request for Proposal is submitted for the express purpose of inducing the Owner to award a contract.
A material false statement or omission made in conjunction with this proposal is sufficient cause for suspension or debarment from further contracts, or denial of rescission of any contract entered into based upon this proposal thereby precluding the firm from doing business with, or performing work for, the State of Georgia. In addition, such false statement or omission may subject the person and entity making the proposal to criminal prosecution under the laws of the State of Georgia of the United States, including but not limited to O.C.G.A. §16-10-20, 18 U.S.C.
§§1001 or 1341.
Signature Sworn and subscribed before me
This _____ day of ________, 20__.
NOTARY PUBLIC
NOTARY SEAL
My Commission Expires: _________________
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