Business Self-Certification Form

PENALTY FOR FALSE MISREPRESENTATION NOTE: In order to complete the attached signature PDF link within this form, you will need to use Google Chrome or Firefox. Use of Microsoft Edge or Apple Safari will require the Adobe Application. Please upload the company signature page. This form must be signed and attached as a PDF or you may open the form using Google Chrome or Firefox which allows for signature directly within the PDF. Misrepresentations of business status as a small, small disadvantaged 8(a), small women-owned, small veteran-owned (including service disabled), and HUBZone small business concern for the purpose of obtaining a subcontract that is to be included as part of or all of a goal contained in the requesting Contractor’s subcontracting plan, without remedy, can result in severe penalties. Additionally, Under 15 U.S.C. 645(d), any person who misrepresents a firm’s status as a business concern that is small, HUBZone small, small disadvantaged, service-disabled veteran-owned small, economically disadvantaged women-owned small, or women-owned small eligible under the WOSB Program in order to obtain a contract to be awarded under the preference programs established pursuant to section 8, 9, 15, 31, and 36 of the Small Business Act or any other provision of Federal law that specifically references section 8(d) for a definition of program eligibility, shall (1) Be punished by imposition of fine, imprisonment, or both; (2) Be subject to administrative remedies, including suspension and debarment; and (3) Be ineligible for participation in programs conducted under the authority of the Act. By signing below, the supplier/vendor hereby certifies and represents that the information provided is current, accurate, and complete. The supplier further certifies that it will notify AEP of any changes to information provided.