1-IFB 26-1-23301 Vol.3 (2a-d) Certification forms.pdf

Madison County Transit IFB Volume 3 of 5

Federal Tax Liability and Recent Felony Convictions (contracts >$10,000)

Instructions: (1) Vendors must file this certification required by 48 Chapter 1, Subchapter H, Part 52 that it does not have any unpaid Federal tax liability and it has not been convicted of any Federal felony within the preceding 24 months. (2) This term apply to all subcontracts at every tier.

Certification: If the bidder/proposer is a private corporation, partnership, trust, joint-stock company, sole proprietorship, or other business association, the applicant certifies that:

(a) It has no unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability; and

(b) It has not been convicted of a felony criminal violation under any Federal law within the preceding 24 months

Date

Company

Signature

Title

Lobbying Certification The undersigned certifies, to the best of his or her knowledge and belief, that:

(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.

(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, “Disclosure Form to Report Lobbying,” in accordance with its instructions.

(3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.

This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

Date Company Signature

Certification of Compliance with the John S. McCain National Defense Authorization Act

__________________________________(Vendor) hereby acknowledges that the John S. McCain National Defense Authorization Act for Fiscal Year 2019, Pub. L.

115232, § 889 (Aug. 13, 2018) (the Act) prohibits the Madison County Mass Transit District (District) from procuring certain '"covered telecommunications equipment or services," as defined in the Act, in federally assisted procurements and that the instant procurement is a federally assisted procurement subject to that prohibition. Vendor represents and warrants that it has performed a due diligence review of its supply chain and that no such "covered telecommunications equipment or services" shall be provided to the District that would cause the District to be in violation of the prohibition contained in the Act.

Date ___________________________________

Signature __________________________________

Title ___________________________________

Buy America Certification

49 CFR 661.6 Certification requirements for procurement of steel or manufactured products.

If steel, iron, or manufactured products (as defined in Sec. 49 CFR 661.3 and 661.5) are being procured, the appropriate certificate as set forth below shall be completed and submitted by each bidder or offeror in accordance with the requirement contained in Sec. 49 CFR 661.13(b).

Bidder shall complete only one certification. DO NOT SIGN BOTH CERTIFICATIONS.

Certificate of Compliance with Buy America Requirements

The bidder or offeror hereby certifies that it will comply with the requirements of 49 U.S.C.

5323(j)(1), and the applicable regulations in 49 CFR part 661.

Date Signature Company Name

Certificate of Non-Compliance with Buy America Requirements

The bidder or offeror hereby certifies that it cannot comply with the requirements of 49 U.S.C.

5323(j), but it may qualify for an exception to the requirement pursuant to 49 U.S.C. 5323(j)(2), as amended, and the applicable regulations in 49 CFR 661.7.

Date Signature Company Name