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8D Consent 2011 1003
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8D Consent 2011 1003
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Last modified
11/2/2011 1:01:27 PM
Creation date
9/27/2011 4:46:21 PM
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CM City Clerk-City Council
CM City Clerk-City Council - Document Type
Staff Report
Document Date (6)
10/3/2011
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PERM
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_CC Agenda 2011 1003
(Reference)
Path:
\City Clerk\City Council\Agenda Packets\2011\Packet 2011 1003
Reso 2011-174
(Reference)
Path:
\City Clerk\City Council\Resolutions\2011
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, under penalty of perjury, certifies that, except as noted below, the company, its <br />principal, and any named subcontractor: <br />1.1 Is not currently under suspension, debarment, voluntary exclusion, or determination <br />of ineligibility by any Federal agency; <br />1.2 Has not been suspended, debarred, voluntarily excluded or determined ineligible by <br />any Federal agency within the past three years; <br />1.3 Does not have a proposed debarment pending; and, <br />1.4 Has not been indicted, convicted, or had a civil judgment rendered against it by a <br />court of competent jurisdiction in any matter involving fraud or official misconduct <br />within the past three years. <br />If there are any exceptions to this certification, insert the exceptions in the following space. <br />Exceptions shall not necessary result in denial of award, but shall be considered in <br />determining Proposer responsibility. For any exception noted above, indicate below to <br />whom it applies, initiating agency, and dates of action. <br />4. Providing false information may result in criminal prosecution or administrative sanctions. <br />The above certification is part of the Agreement. Signing the Agreement on the signature <br />portion thereof shall also constitute signature of this Certification. <br />Name: <br />Signature: <br />Title: <br />Date: f f <br />
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