NEW JERSEY SCHOOLS DEVELOPMENT AUTHORITY
CERTIFICATION OF NON-DEBARMENT FORM
NJSDA Contract No:
Contract Name:
Bidder Name:
Bidder Address:
STATEMENT OF NON-DEBARMENT OF BIDDER OR ASSOCIATED ENTITIES
Pursuant to Public Law 2019, c.406 (codified at N.J.S.A. 52:32-44.1), I, the undersigned, being duly authorized to
complete this certification on behalf of the above-named Bidder, hereby certify and attest, under penalty of perjury,
that:
The Bidder is not debarred at the federal level from contracting with the federal government; and
None of the parent entities, subsidiaries, or affiliates identified on the Ownership Disclosure Form submitted by
the Bidder in connection with the procurement for the above-referenced NJSDA Contract Number as owning 50%
or more of the Bidder are debarred at the federal level from contracting with the federal government.
Failure to complete and submit this Certification Form will render the Bidder’s proposal non-responsive. If the
NJSDA finds a person or entity to be in violation of the law, it shall take action as may be appropriate and permitted
by law, rule or contract, including but not limited to, imposing sanctions, seeking compliance, recovering damages,
declaring the party in default and/or seeking debarment or suspension of the party.
CERTIFICATION
I, the undersigned, certify that I am authorized to execute this certification on behalf of the Bidder, that the foregoing
information and any attachments hereto, are true and complete. I acknowledge that the NJSDA is relying on the
information contained herein, and that the Bidder is under a continuing obligation from the date of this certification
through the completion of any contract(s) with the NJSDA to notify the NJSDA in writing of any changes to the
information contained herein. I am aware that it is a criminal offense to make a false statement or misrepresentation
in this certification. If I do so, I will be subject to criminal prosecution under the law, and it will constitute a material
breach of my agreement(s) with the NJSDA, permitting the NJSDA to declare any contract(s) resulting from this
certification void and unenforceable.
Signature:
Print Name:
Title:
Date:
April 23, 2020 CND
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