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Procedure for the procurement of consulting service - DOH

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<strong>DOH</strong> CUSTOMIZED PROCUREMENT MANUAL VOLUME 4 2010<br />

Certification:<br />

I, <strong>the</strong> undersigned, certify that to <strong>the</strong> best <strong>of</strong> my knowledge and belief, <strong>the</strong>se data correctly describe me, my qualifications, and<br />

my experience. I understand that any willful misstatement described herein may lead to an administrative penalty <strong>of</strong> suspension<br />

and/or <strong>for</strong>feiture <strong>of</strong> per<strong>for</strong>mance security <strong>of</strong> <strong>the</strong> firm that I am part <strong>of</strong> in this undertaking as stated in Section 69, Rule XXIII <strong>of</strong> RA<br />

9184<br />

Date: ___________________________________<br />

Day/Month/Year<br />

[Signature <strong>of</strong> staff member and authorized representative <strong>of</strong> <strong>the</strong> firm]<br />

Full name <strong>of</strong> staff member: ______________________________________<br />

Full name <strong>of</strong> authorized representative: ___________________________<br />

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