[Code of Federal Regulations]
[Title 48, Volume 6]
[Revised as of October 1, 2005]
From the U.S. Government Printing Office via GPO Access
[CITE: 48CFR1609.471]

[Page 124-125]
 
            TITLE 48--FEDERAL ACQUISITION REGULATIONS SYSTEM
 
  CHAPTER 16--OFFICE OF PERSONNEL MANAGEMENT FEDERAL EMPLOYEES HEALTH 
                     BENEFITS ACQUISITION REGULATION
 
PART 1609_CONTRACTOR QUALIFICATIONS--Table of Contents
 
         Subpart 1609.4_Debarment, Suspension, and Ineligibility
 
Sec. 1609.471  Contractor certification.

    All FEHBP carriers and applicant carriers are required to submit the 
following certification. Applicant carriers must submit the 
certification prior to OPM's determination on the application for 
approval to participate in the FEHBP. Current carriers must submit the 
certification once, along with their benefit and rate proposals for the 
1995 contract year.

  Debarment, Suspension, Proposed Debarment, and Other Responsibility 
                                 Matters

    The Carrier certifies, to the best of its knowledge and belief, 
that--
    (a) The Carrier and/or any of its Principals--
    (1) Are ( ) are not ( ) presently debarred, suspended, proposed for 
debarment, or declared ineligible for the award of contracts by any 
Federal agency;
    (2) Have ( ) have not ( ), within a 3-year period preceding this 
certification, been convicted of or had a civil judgment rendered 
against them for: Commission of fraud or a criminal offense in 
connection with obtaining, attempting to obtain, or performing a public 
(Federal, state, or local) contract or subcontract; violation of Federal 
or state antitrust statutes relating to the submission of offers; or 
commission of embezzlement, theft, forgery, bribery, falsification or 
destruction of records, making false statements, or receiving stolen 
property; and
    (3) Are ( ) are not ( ) presently indicted for, or otherwise 
criminally or civilly charged by a governmental entity with, commission 
of

[[Page 125]]

any of the offenses enumerated in subdivision (a)(2) of this clause.
    (4) The Carrier has ( ) has not ( ), within a 3-year period 
preceding this certification, had one or more contracts terminated for 
default by any Federal agency.
    (b) Principals, for the purposes of this certification, means 
officers; directors; owners; partners; and persons having primary 
management or supervisory responsibilities within a business entity 
(e.g., general manager; plant manager; head of a subsidiary, division, 
or business segment, and similar positions).
    This certification concerns a matter within the jurisdiction of an 
agency of the United States and the making of a false, fictitious, or 
fraudulent certification may render the Carrier subject to prosecution 
under section 1001, title 18, United States Code.
    (c) The Carrier shall provide immediate written notice to the 
Contracting Officer if, at any time, the Carrier learns that its 
certification was erroneous when submitted or has become erroneous by 
reason of changed circumstances.
    (d) A Carrier's certification that any of the actions mentioned in 
the certification exists will not necessarily result in termination of 
the contract. However, the certification, or the Carrier's failure to 
provide such additional information as requested by the Contracting 
Officer, will be considered in connection with a determination of the 
Carrier's responsibility under subpart 1609.70, Minimum Standards for 
Health Benefits Carriers.
    (e) Nothing contained in the certification shall be construed to 
require establishment of a system of records in order to render, in good 
faith, the certification required by this section. The knowledge and 
information of the Carrier is not required to exceed that which is 
normally possessed by a prudent person in the ordinary course of 
business dealings.
    (f) The certification in this section is a material representation 
of fact upon which reliance is placed by the Contracting Officer. If it 
is later determined that the Carrier knowingly rendered an erroneous 
certification, in addition to other remedies available to the 
Government, the Contracting Officer may terminate the contract for 
default.

Carrier Name:___________________________________________________________
________________________________________________________________________

Name of Chief Executive Officer

Date signed:____________________________________________________________

                          (End of certificate)