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13
City of Pleasanton
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CITY CLERK
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AGENDA PACKETS
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2013
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041613
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13
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4/10/2013 2:53:58 PM
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4/10/2013 2:53:45 PM
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CITY CLERK
CITY CLERK - TYPE
AGENDA REPORT
DOCUMENT DATE
4/16/2013
DESTRUCT DATE
15Y
DOCUMENT NO
13
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Master Contract No.900973,Procurement Contract No.7485 <br /> EXHIBIT D <br /> COUNTY OF ALAMEDA <br /> DEBARMENT AND SUSPENSION CERTIFICATION <br /> The contractor, under penalty of perjury, certifies that, except as noted below, <br /> contractor, its principals, and any named and unnamed subcontractor: <br /> • Is not currently under suspension, debarment, voluntary exclusion, or <br /> determination of ineligibility by any federal agency; <br /> • Has not been suspended,debarred, voluntarily excluded or determined <br /> ineligible by any federal agency within the past three years; <br /> • Does not have a proposed debarment pending; and <br /> • Has not been indicted, convicted, or had a civil judgment rendered against it by <br /> a court of competent jurisdiction in any matter involving fraud or official <br /> misconduct within the past three years. <br /> If there are any exceptions to this certification,insert the exceptions in the following <br /> space. <br /> Exceptions will not necessarily result in denial of award, but will be considered in <br /> determining contractor responsibility. For any exception noted above, indicate below <br /> to whom it applies, initiating agency, and dates of action. <br /> Notes: Providing false information may result in criminal prosecution or <br /> administrative sanctions. The above certification is part of the Standard Services <br /> Agreement. Signing this Standard Services Agreement on the signature portion <br /> thereof shall also constitute signature of this Certification. <br /> CONTRACTOR: C ;+I/_ o ! P/CctSa,J fc)� <br /> PRINCIPAL: i„ I ,� TITLE: 7. re-G/cr Opera 1 rcn/S <br /> SIGNATURE: �,,,,,, , +' DATE: 5//11 <br />
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