1-BPM006062_SPO_Form_205A_-_Annual_Forced_Labor_of_Ethnic_Uyghurs_Ban_2022_11.pdf
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- Attached to
- Master Agreement AZ|CTR071340
- Contract number
- CTR071340
- Issued by
- Arizona
About this file
The document is an Annual Forced Labor of Ethnic Uyghurs Ban Certification form issued by the Arizona Department of Transportation (ADOT) under Arizona Revised Statutes § 35-394. It requires companies entering into contracts with public entities to certify that they do not use forced labor of ethnic Uyghurs in the People's Republic of China, nor do they use goods or services produced by such labor. The specific form is completed by K & K Systems, Inc., located in Tupelo, Mississippi, and is valid until the end of the current fiscal year (June 30).
The certification is designed to cover multiple off-contract purchases from the same supplier throughout a fiscal year, eliminating the need for repeated certifications. Companies must declare whether they use forced Uyghur labor, with exemptions available for sole proprietorships, companies with fewer than 10 employees, and non-profit organizations. In this case, K & K Systems, Inc. has checked the box affirming that they do not use forced labor of ethnic Uyghurs in China, nor do they use any goods, services, contractors, subcontractors, or suppliers involved in such labor practices. The form must be included with purchase order documentation and renewed prior to each fiscal year to remain compliant with the law.
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Procurement
Annual Forced Labor of Ethnic Uyghurs Ban Cer:fica:on
Pursuant to A.R.S. § 35-394, wri:en cer;fica;on is required to show that the company entering into a contract with a public en;ty does not use the forced labor, or any goods or services produced by the forced labor, of ethnic Uyghurs in the People's Republic of China.
The purpose of this cer;fica;on is to cover instances in which state agencies have mul;ple off-contract purchases from the same supplier over the course of a single fiscal year. Instead of asking suppliers to sign a cer;fica;on each ;me there is an off-contract purchase, this form may be signed once, but cover the whole fiscal year. To comply with this law, a copy of the current year’s cer;fica;on must be included with the documenta;on for each off-contract purchase with the Purchase Order Terms and Condi;ons. To remain compliant with the law, this form must be completed by the supplier prior to each fiscal year.
Please note that if any of the following apply to the Contractor, then the Offeror shall select the “Exempt Contractor” op:on below:
• Contractor is a sole proprietorship;
• Contractor has fewer than ten (10) employees; OR
• Contractor is a non-profit organiza;on.
In compliance with A.R.S. §§ 35-394 et seq., all offerors must select one of the following:
Cer:fica:on is valid un:l the end of the current fiscal year (June 30) aWer the date of signature.
The Company submiYng this Offer does not use, and agrees not to use during the term of the contract, any of the following:
• Forced labor of ethnic Uyghurs in the People’s Republic of China;
• Any goods or services produced by the forced labor of ethnic Uyghurs in the People’s Republic of China; or
• Any Contractors, Subcontractors, or suppliers that use the forced labor or any goods or services produced by the forced labor of ethnic Uyghurs in the People’s Republic of China.
The Company submiYng this Offer does par:cipate in use of Forced Uyghurs Labor in the People’s Republic of China as described in A.R.S. § 35-394.
Exempt Contractor Indicate which of the following statements applies to this Contractor (may be more than one):
☐ Contractor is a sole proprietorship;
☐ Contractor has fewer than ten (10) employees; and/or ☐ Contractor is a non-profit organiza;on.
Company Name Signature of Person Authorized to Sign
Address Printed Name and Title
City State Zip Contact Email Address
BPM006062 SPO Form 205A – Annual Forced Labor of Ethnic Uyghurs Ban Cer;fica;on | Revision No. 1 | Revised 11-22
Alice Bingham X
Alice Bingham
K & K SYSTEMS, INC.
Alice Bingham
687 PALMETTO RD.
Alice Bingham
TUPELO, MS 38801
Alice Bingham
ALICE K BINGHAM, ACCOUNT MANAGER
Alice Bingham ali@k-ksystems.com
Procurement
Annual Forced Labor of Ethnic Uyghurs Ban Cer:fica:on
Date Contact Phone Number
BPM006062 SPO Form 205A – Annual Forced Labor of Ethnic Uyghurs Ban Cer;fica;on | Revision No. 1 | Revised 11-22
Alice Bingham 03/25/2024
Alice Bingham 662-566-2025
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