Integrity declaration form

Integrity declaration form (PDF 1.1Mb)

An Integrity declaration form must be submitted when one or more of the following conditions apply:

  1. the supplier has, in the past three years, been charged with or convicted of one of the offences listed in the Ineligibility and Suspension Policy (the “policy”); and/or
  2. the supplier has, in the past three years, been charged with or convicted of a criminal offence in a country other than Canada that, to the best of the supplier’s knowledge and belief, may be similar to one of the offences listed in the policy; and/or
  3. one of the supplier’s affiliatesFootnote 1 has, in the past three years, been convicted of one of the offences listed in the policy, or has, in the past three years, been convicted of a criminal offence in a country other than Canada that, to the best of the supplier’s knowledge and belief, may be similar to one of the offences listed in the policy; and/or
  4. the supplier is unable to provide any of the certifications required by the Integrity provisions

Instructions for submitting an Integrity declaration form

Suppliers submitting bids by regular mail

  1. Please complete the Integrity declaration form by providing the information requested
  2. Put the completed form in a sealed envelope labeled, “Protected B”, and addressed to:

    Departmental Oversight Branch
    Public Works and Government Services Canada
    L'Esplanade Laurier, West Tower
    300 Laurier Avenue West
    Floor 10, Room 10149
    Ottawa, ON  K1A 0R5
    Canada

  3. Include the sealed envelope with your bid submission, offer or lease

Suppliers submitting bids through the Electronic Procurement Solution (“SAP Ariba”) or by Canada Post epost Connect

  1. Please complete the Integrity declaration form by providing the information requested
  2. Save or scan a signed copy of the document
  3. Send an email to tpsgc.surveillancedelintegrite-integritycheck.pwgsc@tpsgc-pwgsc.gc.ca indicating that you would like to submit the form via epost Connect.

    Do not send the completed form directly to this email

  4. Upon receipt of your email, an epost Connect conversation will be opened with you using the email address that you provided
  5. Follow the instructions in the email to submit the completed form

Note

Only the completed form should be sent to this ePost Connect inbox. All remaining bid materials must be sent to the address provided in the solicitation documentation.

Any other material sent to this address will not be read or forwarded, and this may result in a bid not being considered.

Section 1: Supplier information

Section 2: Foreign criminal offences

If applicable, please provide a complete list of all foreign criminal charges and convictions, received in the past three years, pertaining to you, and foreign criminal convictions pertaining to your affiliates that, to the best of your knowledge and belief, may be similar to one of the domestic criminal offences listed in the policy.

If there is more than one potentially similar foreign charge or conviction, please identify all additional charges and convictions received in the past three years, including the information below, in a separate document under the heading Foreign Criminal Offences, to be included with this form.

Specify whether charge or conviction
Additional charges/convictions are identified in a separate document included with this form

Section 3: Inability to provide a certificate

A. Foreign criminal offences

Inability to Certify as to Foreign Criminal Charges and Convictions included (required)

If you are unable to certify that you have provided the required list of all foreign criminal charges and convictions received in the past three years, you must explain why. The explanation should be provided in a separate document under the heading Inability to Certify as to Foreign Criminal Charges and Convictions, to be included with this form.

Public Works and Government Services Canada (PWGSC) may request additional information from you if needed.

An explanation regarding foreign criminal charges and convictions received in the past three years is provided in a separate document included with this form.

B. Domestic criminal offences and other circumstances

If a domestic criminal offence or other circumstance described in the policy applies to you or one of your affiliates, you must identify that offence or circumstance, below.

By marking a box beside an offence, you are acknowledging that the identified party, be it you or an affiliate, has been charged with, convicted of or pleaded guilty to, that offence in the past three years.

In the row titled “Comments”, you must identify the affected party by name and specify how the particular offence you have identified applies to the named party.

Domestic criminal offences
Offence Supplier Affiliate
Financial Administration Act
80(1)(d): False entry, certificate or return
80(2): Fraud against Her Majesty
154.01: Fraud against Her Majesty
Criminal Code
121: Frauds on the government and contractor subscribing to election fund
124: Selling or purchasing office
380: Fraud – committed against Her Majesty
418: Selling defective stores to Her Majesty
119: Bribery of judicial officers
120: Bribery of officers
346: Extortion
366: Forgery
367: Punishment for forgery
368: Use, trafficking or possession of a forged document
382: Fraudulent manipulation of stock exchange transactions
382.1: Prohibited insider trading
397: Falsification of books and documents
422: Criminal breach of contract
426: Secret commissions
462.31: Laundering proceeds of crime
467.11: Participation in activities of criminal organization
467.12: Commission of offence for criminal organization
467.13: Instructing commission of offence for criminal organization
Competition Act
45: Conspiracies, agreements or arrangements between competitors
46: Foreign directives
47: Bid rigging
49: Agreements or arrangements of federal financial institutions
52: False or misleading representation
53: Deceptive notice of winning a prize
Corruption of Foreign Public Officials Act
3: Bribing a foreign public official
4: Accounting
5: Offence committed outside Canada
Controlled Drugs and Substances Act
5: Trafficking in substance
6: Importing and exporting
7: Production of substance
Lobbying Act
Registration of lobbyists
5: Consultant lobbyists
7: In-house lobbyists (corporations and organizations)
Income Tax Act
239: False or deceptive statements
Excise Tax Act
327: False or deceptive statements

C. Inability to certify as to a determination of ineligibility or suspension

Inability to certify as to a determination of ineligibility or suspension included

If you are aware of a determination of ineligibility or suspension with respect to you, one of your affiliates or a proposed first-tier subcontractorFootnote 2, you should explain the circumstances in this form, including details relating to your capacity to participate in a federal contracting process. With respect to an ineligible or suspended subcontractor, include a copy of the written consent provided by the contracting department or agency to propose the ineligible or suspended subcontractor.

If you are otherwise unable to certify that you are unaware of a determination of ineligibility or suspension with respect to you, one of your affiliates or a proposed first-tier subcontractor you must explain why.

All required explanations should be provided in a separate document, under the heading Inability to certify as to a determination of ineligibility or suspension, to be included with this form.

PWGSC may request additional information from the supplier.

An explanation regarding a determination of ineligibility or suspension is provided in a separate document included with this form: (required)

Declaration

I, (name), (position), of (supplier’s name) declare that the information provided in this form is, to the best of my knowledge and belief, true, accurate and complete. I am aware that PWGSC may request additional information relating to this declaration. I am aware that a false or misleading certification or declaration will result in my proposal or offer being deemed non-responsive. I am also aware that Canada may terminate a contract or real property agreement for default when a supplier has provided a false or misleading certification or declaration and, further to the policy, the supplier will be ineligible for award of a contract or real property agreement for 10 years.


Signature

Date

Telephone

Email address

With thanks

We appreciate your interest in doing business with the Government of Canada and your understanding of the steps that must be taken to protect the integrity of Canada’s procurement and real property processes.

Guidance document for the Integrity declaration form

This Integrity declaration form (the “form”) is for use by bidders in procurement processes and by vendors, purchasers, tenants and lessors in real property transactions. In this form, the term “supplier” includes bidders, vendors, purchasers, tenants and lessors. The term “party” is used in this form to include suppliers and affiliates.

The Integrity provisions contained in instruments involved in procurement processes and real property transactions require a supplier to submit an Integrity declaration form when one or more of the following conditions apply:

  1. the supplier has, in the past three years, been charged with or convicted of one of the offences listed in the Ineligibility and Suspension Policy (the “policy”); and/or
  2. the supplier has, in the past three years, been charged with or convicted of a criminal offence in a country other than Canada that, to the best of the supplier’s knowledge and belief, may be similar to one of the offences listed in the policy; and/or
  3. one of the supplier’s affiliatesFootnote 1 has, in the past three years, been convicted of one of the offences listed in the policy, or has, in the past three years, been convicted of a criminal offence in a country other than Canada that, to the best of the supplier’s knowledge and belief, may be similar to one of the offences listed in the policy; and/or
  4. the supplier is unable to provide any of the certifications required by the Integrity provisions

The form must be submitted only when one or more of these circumstances applies to the supplier. When no form is submitted, it will be understood to mean that none of these circumstances apply to the supplier.

A supplier that provides a false or misleading certification or declaration will have its proposal or offer deemed non-responsive. Canada may also terminate a contract or real property agreement for default in such circumstances. Moreover, further to the policy, a supplier will be ineligible for award of a contract or real property agreement for 10 years.

1. Foreign criminal offences

The policy provides, among other things, that a supplier may be ineligible for award of a contract or real property agreement when the supplier has, in the past three years been charged with; or the supplier or one of its affiliates has, in the past three years, been convicted of a similar offence in a foreign jurisdiction. The Integrity provisions require a supplier to provide a complete list of all foreign criminal charges and convictions, received in the past three years, pertaining to itself, and all foreign criminal convictions pertaining to its affiliates that, to the best of its knowledge and belief, may be similar to one of the domestic criminal offences listed in the policy. The domestic offences listed in the policy, including their section numbers, are identified section B of this form, under the heading Domestic Criminal Offences and Other Circumstances. PWGSC determines whether a foreign offence and an offence listed in the policy are similar. PWGSC may seek additional information from a supplier for purposes of making this determination.

If there is more than one potentially similar foreign charge or conviction, please identify all additional charges and convictions, including all the necessary information, in a separate document under the heading Foreign Criminal Offences, to be included with this form.

2. Inability to provide a certificate

The Integrity provisions provide that, by submitting a bid or offer, a supplier is certifying to the truth of the statements described by the provisions.

Generally speaking, a supplier is certifying that:

  1. it has read and understands the policy, including that it may be declared ineligible to enter into a contract or real property agreement with Canada in certain circumstances
  2. none of those circumstances that will or may result in the supplier being ineligible to enter, or suspended from entering, a contract or real property agreement apply to it; and
  3. it has provide a complete list of all foreign criminal charges and convictions received in the past three years, pertaining to itself, and all foreign criminal convictions pertaining to its affiliates that, to the best of its knowledge and belief, may be similar to one of the domestic offences listed in the policy

When a supplier is unable to provide any of the certifications required by the Integrity provisions, it must complete and submit this form with its bid or offer.

A. Foreign criminal charges and convictions

As noted above, the Integrity provisions require a supplier to provide a complete list of all foreign criminal charges and convictions, received in the past three years, pertaining to itself, and all foreign criminal convictions pertaining to its affiliates received in the past three years that, to the best of its knowledge and belief, may be similar to one of the domestic criminal offences listed in the policy. The complete list of foreign criminal charges and convictions, if any, must be submitted using this form. By submitting a bid or offer, a supplier is certifying that it has provided a complete list of all such foreign criminal charges and convictions, if any.

If a supplier is unable to certify that it has provided the required list of all foreign criminal charges and convictions received in the past three years, it must explain why. The explanation should be provided in a separate document under the heading Foreign Criminal Charges and Convictions, to be included with this form.

PWGSC may request additional information from the supplier.

B. Domestic criminal offences and other circumstances

The Integrity provisions require a supplier to certify that, in the past three years, none of the domestic criminal offences listed in sections 6(a) to (c) of the policy, as identified in section 3.B of this form, and other circumstances described in the policy, that will or may result in a determination of ineligibility or suspension, apply to it or one of its affiliates. This applies when a supplier has been charged with, convicted of or pleaded guilty to, a criminal offence in the past three years and has not received a pardon for the offence Footnote 3, or when an affiliate has been convicted of or pleaded guilty to, a criminal offence in the past three years and has not received a pardon for the offence Footnote 3. Other circumstances identified in the policy that will or may result in ineligibility or suspension include entering into a first-tier subcontract with an ineligible or suspended supplier [policy, s. 6(d)], providing a false or misleading certification or declaration [policy, s. 6(e)] and breaching a term or condition of an Administrative Agreement with PWGSC [policy, s. 7(c)].

When a criminal offence or other circumstance described in the policy, occurring in the past three years, applies to a supplier or one of its affiliates, the supplier must identify that offence or circumstance. By marking a box beside an offence, a supplier is acknowledging that in the past three years, the identified party, be it the supplier or an affiliate, has been charged with, convicted of or pleaded guilty to, that offence. In the row titled Comments, the suppler must identify the affected party by name and specify how the particular offence it has identified applies to the named party.

C. Inability to certify as to a determination of ineligibility or suspension

The Integrity provisions require a supplier to certify that it is not aware of a determination of ineligibility or suspension issued by PWGSC that applies to it, one of its affiliates or a proposed first-tier subcontractor. The process for determining the status of a party under the policy is described in section 16(b) of the policy. When a supplier is unable to provide this certification, it must complete this form.

Under section 15 of the policy, titled Public Interest Exception (“PIE”) a contracting authority may enter into a contract or real property agreement with an ineligible or suspended supplier in narrow circumstances if the relevant Deputy Head or equivalent considers that doing so is in the public interest. Subject to receiving a PIE, an ineligible or suspended supplier that participates in a competitive solicitation or real property transaction will be declared non-responsive [policy, s. 13(c)]. A supplier seeking a PIE in a competitive process would be unable to certify as to the absence of a determination with respect to itself.

Similarly, under section 16(e) of the policy, a supplier may seek, in advance, the written consent of the relevant Deputy Head or equivalent to propose an ineligible or suspended first-tier subcontractor in a competitive process. Such request should be made through the named contracting or real property authority. A supplier that has obtained, in advance, written consent to use an ineligible or suspended first-tier subcontractor would be unable to certify as to the absence of a determination with respect to the subcontractor.

It should be noted, however, that a Deputy Head or equivalent cannot provide consent to contract with a supplier that has lost its capacity to contract with Canada, further to subsection 750(3) of the Criminal Code. Similarly, consent cannot be provided for a supplier to enter into a first-tier subcontract with a subcontractor that has lost its capacity to receive any benefit under a contract between Canada and any other person, further to subsection 750(3) of the Criminal Code.

When a supplier is aware of a determination of ineligibility or suspension with respect to itself, one of its affiliates or a proposed first-tier subcontractor it should explain the circumstances of its participation in the competitive process. If the supplier is seeking a PIE, it should explain why it is in the public interest to be awarded the contract. With respect to an ineligible or suspended subcontractor, the supplier should include a copy of the written consent to propose the ineligible or suspended subcontractor.

When a supplier is otherwise unable to certify that it is unaware of a determination of ineligibility or suspension with respect to itself, one of its affiliates or a proposed first-tier subcontractor it must explain why.

All required explanations should be provided in a separate document, under the heading Inability to Certify as to a Determination of Ineligibility or Suspension, to be included with this form.

PWGSC may request additional information from the supplier.

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