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08
City of Pleasanton
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CITY CLERK
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AGENDA PACKETS
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2017
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091917
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08
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9/14/2017 4:10:33 PM
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CITY CLERK
CITY CLERK - TYPE
AGENDA REPORT
DOCUMENT DATE
9/19/2017
DESTRUCT DATE
15Y
DOCUMENT NO
08
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COUNTY OF Ai ,AMEDA <br />DEBARMENT AND SUSPENSION CERTIFICATION <br />(Applicable to all agreements funded in part or whole with federal funds and contracts over $25,000). <br />The contractor, under penalty of perjury, certifies that, except as noted below, contractor, its principals, <br />and any named and 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 any federal <br />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 of <br />competent jurisdiction in any matter involving fraud or official misconduct within the past three <br />years. <br />If there are any exceptions to this certification, insert the exceptions in the following space. <br />Exceptions will not necessarily result in denial of award, but will be considered in determining contractor <br />responsibility. For any exception noted above, indicate below to whom it applies, initiating agency, and <br />dates of action. <br />Notes: Providing false information may result in criminal prosecution or administrative sanctions. The <br />above certification is part of the Standard Services Agreement. Signing this Standard Services <br />Agreement on the signature portion thereof shall also constitute signature of this Certification. <br />CONTRACTOR: CITY OF PLEASANTON <br />PRINCIPAL: Nelson Fialho TITLE: City Manager <br />SIGNATURE: DATE: <br />
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