RoboCam F12 Specifikace Strana 53

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DEBARMENTCERTIFICATION
Inconnectionwiththisbidandallprocurementtransactions,by signaturethereon,the
respondentcertifiesthatneitherthecompanynoritsprincipalsaresuspended,debarred,
proposedfordebarment,declaredineligible,orvoluntarilyexcludedfromtheawardof
contracts,procurementornonprocurementprogramsfromtheCommonwealthof
Massachusetts,theUS
FederalGovernmentand/ortheCityofWaltham.“Principals”means
officers,directors,owners,partnersandpersonshavingprimaryinterest,managementor
supervisoryresponsibilitieswiththebusinessentity.Vendorsshallprovideimmediatewritten
notificationtothePurchasingAgentoftheCityofWalthamatanytimeduringtheperiodofthe
contract
ofpriortothecontractawardifthevendorlearnsofanychangedconditionwith
regardstothedebarmentofthecompanyoritsofficers.Thiscertificationisamaterial
representationoffactuponwhichreliancewillbeplacedwhenmakingthebusinessaward.Ifat
anytimeitis
determinedthatthevendorknowinglymisrepresentedthiscertification,in
additiontootherlegalremediesavailabletothecityofWaltham,thecontractwillbecancelled
andtheawardrevoked.
CompanyName_______________________________________________________________
Address_____________________________________________________________________
City_________________________,State____________________,ZipCode______________
PhoneNumber(____)___________________
EMailAddress________________________________________________________________
SignedbyAuthorizedCompanyRepresentative:
____________________________________________________________________________
Printname__________________________________________________________________,
Date____________________________
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