City of Purchasing Department Newton Telephone Nicholas ReadChief Procurement (617) 796-1220 Officer Fax: 1000 Commonwealth Avenue (617) 796-1227 Mayor Newton Centre, MA 02459-1449 TDD/TTY D. Warren (617) 796-1089 Date Vendor Re: Debarment Letter for Invitation For Bid #15-17 As a potential vendor on the above contract, the City requires that you provide a debarment/suspension certification indicating that you are in compliance with the below Federal Executive Order. Certification can be done by completing and signing this form. Debarment: Federal Executive (E.O.) 12549 and Suspension“ requires that all contractors receiving “Debarment individual awards, using federal funds, and all sub-recipients certify that the organization and its principals are not debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal department or agency from doing business with the Federal Government. I hereby certify under pains and penalties of perjury that neither I nor any principal(s) of the Company identified below is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency. (Name) (Company) (Address) (Address) PHONE FAX EMAIL Signature Date . If you have questions, please contact Nicholas Read, Procurement Officer at (617) 796-1220.
City of Newton Mayor D. Warren Purchasing Department Nicholas ReadChief Procurement Officer 1000 Commonwealth Avenue Newton Centre, MA 02459-1449 Telephone (617) 796-1220 Fax: (617) 796-1227 TDD/TTY (617) 796-1089 Date Vendor Re: Debarment Letter for Invitation For Bid #15-17 As a potential vendor on the above contract, the City requires that you provide a debarment/suspension certification indicating that you are in compliance with the below Federal Executive Order. Certification can be done by completing and signing this form. Debarment: Federal Executive (E.O.) 12549 “Debarment and Suspension“ requires that all contractors receiving individual awards, using federal funds, and all sub-recipients certify that the organization and its principals are not debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal department or agency from doing business with the Federal Government. I hereby certify under pains and penalties of perjury that neither I nor any principal(s) of the Company identified below is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency. (Name) (Company) (Address) (Address) PHONE FAX EMAIL Signature Date . If you have questions, please contact Nicholas Read, Procurement Officer at (617) 796-1220.
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