Government & Public

Debarment / Suspension Certification

Federal contractor certification of non-debarment, non-suspension, and eligibility for covered transactions per FAR 52.209-5 and 2 C.F.R. Part 180.

๐Ÿ“„ 1 signer๐Ÿ“… 30-day expiry๐Ÿท Government & Public๐Ÿ”– debarment, suspension, federal-procurement, government-contract, far, certification

About this template

The Debarment / Suspension Certification is a ready-to-use government & public template you can send for signature in minutes. It is written for 1 signer (contractor) and, by default, expires 30 days after it is sent if left unsigned. It covers debarment, suspension, federal procurement, government contract, far, certification. Like every Abundera Sign template it is a convenience draft structured for ESIGN Act and UETA compliance, not a substitute for legal advice. Each signed copy is sealed with PAdES-LTA digital signatures, dual RFC 3161 timestamps, and a tamper-evident evidence package in WORM storage.

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# Debarment / Suspension Certification ## Background and Purpose Federal regulations require contractors to certify that they are not excluded from participation in federal programs before receiving federal funds, awards, or contracts. This certification is required by: - **FAR 52.209-5** โ€” Certification Regarding Responsibility Matters - **2 C.F.R. Part 180** โ€” OMB Guidelines to Agencies on Governmentwide Debarment and Suspension - **Executive Order 12549** and **12689** โ€” Debarment and Suspension The federal System for Award Management (SAM.gov) maintains the Excluded Parties List System (EPLS). Before executing this certification, the contractor should search SAM.gov to confirm that neither the entity nor any of its principals appears on the exclusions list. **Debarment** is an action taken by a debarring official that excludes a contractor from participating in federal contracting for a specified period. **Suspension** is a temporary exclusion pending completion of investigation or legal proceedings. A contractor that is debarred or suspended is ineligible for federal awards. --- ## Part 1 โ€” Contractor Information **Contractor Legal Name:** ___________ **Doing Business As (DBA), if applicable:** ___________ **Entity Type:** ___________ **Federal Employer Identification Number (EIN):** ___________ **SAM.gov Unique Entity Identifier (UEI):** ___________ **Business Address (Street):** ___________ **City:** ___________ **State:** ___________ **ZIP Code:** ___________ --- ### Primary Contact

Fields (34)

contractor legal name
text ยท required
contractor dba
text
entity type
select ยท required
federal ein
text ยท required
sam uei
text ยท required
business address street
text ยท required
business address city
text ยท required
business address state
text ยท required
business address zip
text ยท required
contact name
text ยท required
contact title
text ยท required
contact phone
phone ยท required
contact email
email ยท required
contract number
text ยท required
agency name
text ยท required
program name
text
contract value
text ยท required
cert a not excluded
checkbox ยท required
cert b no fraud
checkbox ยท required
cert c no financial crimes
checkbox ยท required
cert d no indictment
checkbox ยท required
cert e no principal exclusions
checkbox ยท required
all certs accurate
radio ยท required
disclosure details
textarea
principal 1 name
text
principal 1 title
text
principal 2 name
text
principal 2 title
text
principal 3 name
text
principal 3 title
text
ongoing obligation acknowledged
checkbox ยท required
execution contractor name
text ยท required
execution rep name
text ยท required
execution rep title
text ยท required

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Every signed document gets PAdES-LTA digital signatures, dual RFC 3161 timestamps, and a tamper-evident evidence package sealed in WORM storage.

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