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11
City of Pleasanton
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CITY CLERK
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AGENDA PACKETS
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2016
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050316
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11
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11/30/2016 1:47:49 PM
Creation date
4/29/2016 11:51:13 AM
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CITY CLERK
CITY CLERK - TYPE
AGENDA REPORT
DOCUMENT DATE
5/3/2016
DESTRUCT DATE
15Y
DOCUMENT NO
11
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Master Contract No. 900973 <br /> 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, contractor, its <br /> principals, and any named or unnamed subcontractor: <br /> • Is not currently under suspension, debarment,voluntary exclusion, or determination of <br /> ineligibility by any federal agency; <br /> • Has not been suspended, debarred,voluntarily excluded or determined ineligible by <br /> 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 a court <br /> of competent jurisdiction in any matter involving fraud or official misconduct within <br /> the past three years. <br /> If there are any exceptions to this certification, insert the exceptions in the following space. <br /> Exceptions will not necessary result in denial of award, but will be considered in determining <br /> contractor responsibility. For any exception noted above, indicate below to whom it applies, <br /> initiating agency, and dates of action. <br /> Notes: Providing false information may result in criminal prosecution or administrative <br /> sanctions. The above certification is part of the Standard Services Agreement. <br /> Signing this Standard Services Agreement on the signature portion thereof shall also <br /> constitute signature of this Certification. <br /> CONTRACTOR: CITY OF PLEASANTON <br /> PRINCIPAL: Kathleen Yurchak TITLE: Director of Operations and Water Utilities <br /> SIGNATURE: DATE: <br /> Exhibit D <br /> Page 1 of 1 <br />
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