HomeMy WebLinkAboutDebarment Certificate 2USPENSION AND
CERTIFICATION REGARDING DEBARMENT,
RBr AHD COS EKED TRANSACTIONS OTHER
RESPONSIBILITY MATTERS
1. The applicant certifies to the best of its knowledge and belief, that it and 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 judgement
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 statutes or 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 government entity
(Federal, State, or local) with commission of any of the offenses enumerated in paragraph l.b of this
certification; and
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.
2. Where the prospective primary participant is unable to certify to any of the statements in this certification, such
prospective participant shall submit an explanation to the City of Miami.
James E. _acott Community Aa iociation
APPLICANT/AGENCY
nrrrtri t . Bodo
PRINT NAM s F CERTIFYING OFFICIAL
3//6A!.):-
SIGNA RE OF '! ING OFFICIAL DATE
City of MIAMI STATE OF FLORIDA
The forgoing instrument was acknowledged before me this day of MARCH , 2005
by DorrirkD. Rolle as President & CEO (title)
(name of person whose signature is being notarized)
of ,TAMES E. Sc9TT COMMUNITY ASSQ�IATION. INC. known to me to be the person described herein,
(name of corporation/company)
or who produced
NOTARY
as identification, and who did/did not take an oath.
(Type of Identification)
Althea C. Jackson My commission expires July 10. 2007
(Signature) (Print Name)
SEAL
i` MYCorrwRiailan D0231437e
M1 EkRiws July 1i, IOf7