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2011-204A
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2011-204A
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Last modified
7/19/2019 12:07:28 PM
Creation date
10/1/2015 2:53:55 AM
Metadata
Fields
Template:
Official Documents
Official Document Type
Contract
Approved Date
09/13/2011
Control Number
2011-204A
Agenda Item Number
12.I.1
Entity Name
Timothy Rose Contracting
Subject
Intersection Improvements Indian River Boulevard
Area
Indian River Boulevard and 17th St.
Project Number
1024
Bid Number
2011048
Supplemental fields
SmeadsoftID
10258
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I <br />Certification Regarding Debarment, Suspension, Ineligibility and Voluntary <br />Exclusion --Primary Covered Transactions <br />The Bidder certifies that, the firm or any person associated therewith in the capacity of <br />owner, partner, director, officer, principal, investigator, project director, manager, auditor, and/or <br />position involving the administration of federal funds: <br />I (a) are not presently debarred, suspended, proposed for debarment, declared ineligible, or <br />voluntarily excluded from covered transactions, as defined in 49 CFR s29.1 10(a), by any federal <br />department or agency; <br />(b) have not within a three-year period preceding this certification been convicted of or had <br />a civil judgment rendered against it for: commission of fraud or a criminal offense in connection <br />with obtaining, attempting to obtain, or performing a federal, state, or local government transaction <br />or public contract; violation of federal or state antitrust statutes; or commission of embezzlement, <br />theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving <br />stolen property <br />(c) are not presently indicted for or otherwise criminally or civilly charged by a federal, <br />state, or local governmental entity with commission of any of the offenses enumerated in <br />paragraph (b) of this certification; and <br />(d) have not within athree-year period preceding this certification had one or more federal, <br />state, or local government public transactions terminated for cause or default. <br />The Bidder certifies that it shall not knowingly enter into any transaction with any <br />subcontractor, material supplier, or vendor who is debarred, suspended, declared ineligible, or <br />voluntarily excluded from participation in this project by any federal agency unless authorized by <br />the Florida Department of Transportation." <br />Company Na <br />Authorized B <br />Title: <br />(Sign) (Print Name) <br />eS <br />00476 <br />Date:_ 081 (ArI t I <br />C <br />F:\Public Works\ENGINEERING DIVISION PROJECTS\1024-17th Street and IR Blvd Intersection\Admim\Contract Documents\00476 - <br />Certification Regarding Debarment.doc <br />
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