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Executive
Order 12549 – Certification regarding debarment, suspension
and other responsibility matters
This web page is
for reviewing the following information, but the original
pdf.document should be printed and returned.
Any vendor who may hold a current
contract with Memphis City Schools or wish to participate in a contract
in the future must provide a completed certification regarding debarment,
suspension, and other responsible matters as indicated in the form below.
The form must be submitted by any vendor that wishes to contract with
the District (MCS) for any projects which may include the use
of Federal dollars. By submitting the signed form below, prospective
participants certify to the best of their knowledge that neither it
nor its principals are presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded from participation in this transaction
by any federal department or agency.
CERTIFICATION
REGARDING DEBARMENT, SUSPENSION AND OTHER
RESPONSIBILITY MATTERS –
PRIMARY AND
LOWER TIER COVERED TRANSACTIONS
1. By signing and submitting
this proposal (print the .pdf here for signature), the prospective primary and/or lower tier participant
(“participant”) is providing the certification set out below.
The inability of a person to provide the certification required below
will not necessarily result in denial of participation in this covered
transaction, however failure of the prospective participant to furnish
a certification or explanation shall disqualify such person from participation
in this transaction. The certification or explanation will be
considered in connection with the department or agency’s determination
whether to enter into this transaction.
2. The certification in this
clause is a material representation of fact upon which reliance was
placed when this transaction was entered into. If it is later determined
that the prospective participant knowingly rendered an erroneous certification,
in addition to other remedies available to the Federal Government the
department or agency with which this transaction originated may pursue
available remedies, including termination for cause or default, suspension
and/or debarment.
3. The prospective participant
shall provide immediate written notice to the person to which this proposal
is submitted if at any time the prospective participant learns that
its certification was erroneous when submitted or had become erroneous
by reason of changed circumstances.
4. The terms covered transaction,
debarred, suspended, ineligible, lower tier covered transaction, participant,
person, primary covered transaction, principal, proposal, and voluntarily
excluded, as used in this clause, have the meaning set out in the Definitions
and Coverage sections of rules implementing Executive Order 12549. You
may contact the person to which this proposal is submitted for assistance
in obtaining a copy of those regulations.
5. The prospective participant
agrees by submitting this proposal that, should the proposed covered
transaction be entered into, it shall not knowingly enter into any lower
tier covered transaction with a person who is proposed for debarment
under 48 CFR part 9, subpart 9.4, debarred, suspended, declared ineligible,
or voluntarily excluded from participation in this covered transaction,
unless authorized by the department or agency with which this transaction
originated.
6. The prospective participant
further agrees by submitting this proposal that it will include this
clause titled "Certification Regarding Debarment, Suspension, Ineligibility
and Voluntary Exclusion-Lower Tier Covered Transaction," without
modification, in all covered transactions and in all solicitations for
covered transactions.
7. A participant in a covered
transaction may rely upon a certification of a prospective participant
in a lower tier covered transaction that it is not proposed for debarment
under 48 CFR part 9, subpart 9.4, debarred, suspended, ineligible, or
voluntarily excluded from covered transactions, unless it knows that
the certification is erroneous. A participant may decide the method
and frequency by which it determines the eligibility of its principals.
Each participant may, but is not required to, check the List of Parties
Excluded from Federal Procurement and Nonprocurement Programs.
8. Nothing contained in the
foregoing shall be construed to require establishment of a system of
records in order to render in good faith the certification required
by this clause. The knowledge and information of a participant is not
required to exceed that which is normally possessed by a prudent person
in the ordinary course of business dealings.
9. Except for transactions
authorized under paragraph 5 of these instructions, if a participant
in a covered transaction knowingly enters into a lower tier covered
transaction with a person who is proposed for debarment under 48 CFR
part 9, subpart 9.4, suspended, debarred, ineligible, or voluntarily
excluded from participation in this transaction, in addition to other
remedies available to the Federal Government, the department or agency
with which this transaction originated may pursue available remedies,
including termination of this transaction for cause or default, suspension
and/or debarment.
Certification
Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion—Primary
and/or Lower Tier Covered Transactions
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The prospective
participant certifies to the best of its knowledge, by submission of
this proposal, that neither it nor its principals is presently debarred,
suspended, proposed for debarment, declared ineligible, or voluntarily
excluded from participation in this transaction by any Federal department
or agency.
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The prospective
participant and its principals have not, within a three (3) 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 statutes or commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making
false statements, or receiving stolen property.
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The prospective
participant and its principals 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 in Paragraph 2 of this
certification.
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The prospective
participant and its principals have not, within a three (3) year period
preceding this application/proposal, had one (1) or more public transactions
(Federal, State or local) terminated for cause or default.
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Where the prospective
participant is unable to certify to any of the statements in this certification,
such prospective participant shall attach an explanation to this proposal.
Agency: ________________________________________
Signature: ________________________________________
Date: ________________________________________
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