RoboCam F12 Dokumentacja Pobierz pdf (Strona 53)

DEBARMENTCERTIFICATION

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Inconnectionwiththisbidandallprocurementtransactions,by signaturethereon,the

respondentcertifiesthatneitherthecompanynoritsprincipalsaresuspended,debarred,

proposedfordebarment,declaredineligible,orvoluntarilyexcludedfromtheawardof

contracts,procurementornonprocurementprogramsfromtheCommonwealthof

Massachusetts,theUS

FederalGovernmentand/ortheCityofWaltham.“Principals”means

officers,directors,owners,partnersandpersonshavingprimaryinterest,managementor

supervisoryresponsibilitieswiththebusinessentity.Vendorsshallprovideimmediatewritten

notificationtothePurchasingAgentoftheCityofWalthamatanytimeduringtheperiodofthe

contract

ofpriortothecontractawardifthevendorlearnsofanychangedconditionwith

regardstothedebarmentofthecompanyoritsofficers.Thiscertificationisamaterial

representationoffactuponwhichreliancewillbeplacedwhenmakingthebusinessaward.Ifat

anytimeitis

determinedthatthevendorknowinglymisrepresentedthiscertification,in

additiontootherlegalremediesavailabletothecityofWaltham,thecontractwillbecancelled

andtheawardrevoked.

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CompanyName_______________________________________________________________

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Address_____________________________________________________________________

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City_________________________,State____________________,ZipCode______________

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PhoneNumber(____)___________________

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E‐MailAddress________________________________________________________________

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SignedbyAuthorizedCompanyRepresentative:

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____________________________________________________________________________

Printname__________________________________________________________________,

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Date____________________________

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RoboCam F12 Dokumentacja Strona 53