Orange County NC Website
Submittal of Non-Collusion Affidavit and Debarment Certification prior to bidding <br /> Submit to the Prequalification Office Rev.2-1-10 <br /> DEBARMENT CERTIFICATION <br /> The prequalified bidder certifies to the best of his knowledge and belief, that he and his <br /> principals: <br /> a. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or <br /> voluntarily excluded from covered transactions by any Federal department or agency; <br /> b. Have not within a three-year period preceding this proposal been convicted of or had a civil <br /> judgment rendered against them for commission of fraud or a criminal offense in connection <br /> with obtaining, attempting to obtain, or performing a public (Federal, State or local) <br /> transaction or contract under a public transaction; violation of Federal or State antitrust <br /> statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction <br /> of records; making false statements;or receiving stolen property; <br /> c. Are not presently indicted for or otherwise criminally or civilly charged by a governmental <br /> entity (Federal, State or local) with commission of any of the offenses enumerated in <br /> paragraph b. of this certification;and <br /> d. Have not within a three-year period preceding this proposal had one or more public <br /> transactions(Federal, State or local)terminated for cause or default. <br /> e. Will submit a revised Debarment Certification immediately if his status changes and will <br /> show in his bid proposal an explanation for the change in status. <br /> If the prequalified bidder cannot certify that he is not debarred, he shall provide an explanation <br /> with this submittal. An explanation will not necessarily result in denial of participation in a <br /> contract. <br /> Failure to submit a non-collusion affidavit and debarment certification will result in the <br /> prequalified bidder's bid being considered non-responsive. <br /> F-1 Check here if an explanation is attached to this certification. <br />