TRFP27006857 Debarment.pdf
PDF 199 KB Posted
- Attached to
- RIDOT: ON-CALL TRANSIT PLANNING
- Solicitation number
- TRFP27006857
- Issued by
- Providence County, Rhode Island
About this file
This is a Debarment Certification form required for the TRFP27006857 On-Call Transit Planning Consultant Services project, issued by the State of Rhode Island Department of Administration Division of Purchases on behalf of the Rhode Island Department of Transportation Planning Division. The certification must be completed by prospective primary participants in this solicitation. The form requires certification that principals are not presently debarred, suspended, proposed for debarment, or excluded from covered transactions by any Federal department or agency. Additionally, prospective participants must certify that within the three-year period preceding the proposal, they have not been convicted of or had civil judgments rendered against them for fraud, criminal offenses related to public transactions, antitrust violations, embezzlement, theft, forgery, bribery, falsification of records, false statements, or receipt of stolen property, and that they are not presently indicted or criminally or civilly charged for any such offenses.
The certification further requires that participants confirm they have not had one or more public transactions terminated for cause or default within the three-year period preceding the application. Any prospective participant unable to certify to these statements must list exceptions below, indicating the applicable parties, initiating agency, and dates of action. The form specifies that exceptions will not necessarily result in denial of award but will be considered in determining contractor responsibility. Contractors noting exceptions must contact the Department prior to contract award. False information provided on this certification may result in criminal prosecution or administrative sanctions. The form requires the print name, signature, and date of the authorized representative.
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Text version
CERTIFICATION REGARDING DEBARMENT, SUSPENSION,
AND OTHER RESPONSIBILITY MATTERS
PRIMARY COVERED TRANSACTIONS
In accordance with the code of Federal Regulations, Part 49 CFR Section 29.5 10, the prospective primary participant , , being duly sworn (or executed under penalty of perjury under the laws of the United States), certifies to the best of his/her knowledge and belief, that its principals:
a.) Are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily Excluded from covered transactions by any Federal department or agency;
b.) Have not within a three-year period preceding this proposal been convicted of or had a civil judgment 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 statues or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, 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 (l)(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.
Contract Number:
Contract Name:
Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective participant shall list exceptions below.
Exceptions will not necessarily result in denial of award, but, will be considered in determining contractor responsibility. For any exception noted, indicate below to whom it applies, the initiating agency, and the dates of the action. Providing false information may result in criminal prosecution or administrative sanctions. If an exception is noted the contractor must contact the Department to discuss the exception prior to award of the contract.
Print Name: ___________________________________
Signature: ___________________________________ Date: __________________ Revised 4-7-22
| PrintName: |
| DateDebarment: |
| Project Number: TRFP27006857 |
| Project Name: On-Call Transit Planning Consultant Services |
File details come from the government source that posted it. Updated .