04-23-2020
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CERTIFICATION REGARDING DEBARMENT, SUSPENSION, <br />AND OTHER RESPONSIBILITY MATTERS <br />This certification is required by the regulations implementing Executive Order 12549, Debarment and Suspension, 13 CFR Part 145. The regulations were published as Part VII of the May 26, 1988 Federal Register (pages 19160-19211). <br />(BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS ON PAGE 2) <br />(1) The official representative of the party contracting with the Metro Flood Diversion Authority certifies to the best of its knowledge and belief that it and its principals: <br />(a) Are not presently debarred, suspended, proposed for disbarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; <br />(b) Have not within a three-year period preceding this application been convicted of or had a civil <br />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 <br />embezzlement, theft, forgery, bribery, falsification or destruction 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 entity <br />(Federal, State, or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this certification; and <br />(d) Have not within a three-year period preceding this application had one or more public transactions, <br />including contracts (Federal, State, or local) terminated for cause or default. <br />(e) Are not presently debarred, suspended, declared ineligible or voluntarily excluded from performing work for the State of North Dakota, the State of Minnesota, the Metro Flood Diversion Authority or any of its Member Entities. <br />(2) Where the prospective primary participant is unable to certify to any of the statements in this certification, such prospective primary participant shall attach an explanation to this proposal. <br />(3) The Official signing this certificate has been and is duly authorized to sign this certificate on behalf of the entity or entities which intend to enter into a contract with the Metro Flood Diversion Authority. <br />Official Business Name <br />Date: By: <br />Name and Title of Authorized Representative <br />Signature of Authorized Representative PLEASE RETURN TO: Metro Flood Diversion Authority <br />207 4th St. N, Suite A Fargo, ND 58102
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