HomeMy WebLinkAboutExhibit11EXHIBIT G
CERTIFICATION REGARDING DEBARMENT, SUSPENSION AND OTHER
RESPONSIBILITY MATTERS PRIMARY COVERED TRANSACTIONS
1. The Proposer 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 1.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.
PROPOSER/AGENCY
PRINT NAME OF CERTIFYING OFFICIAL
SIGNATURE OF CERTIFYING OFFICIAL DATE