1-Marvin ADOT Med Boycott.pdf

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PARTICIPATION IN BOYCOTT OF ISRAEL— DEPARTMENT OF —

TRANSPORTATION

Boycott of Israel Disclosure

Please note that if ^ of the following apply to this Solicitation, Contract, or "Exempt Solicitation, Contract, or Contractor" option below:

Contractor, then the Offeror shall select the

● The Solicitation or Contract has an estimated value of less than $100,000;

● Contractor is a sole proprietorship;

. Contractor has fewer than ten (10) employees; OR

● Contractor is a non-profit organization.

written certification that the company engage in, a boycott of goods or services from Israel.'

Under A.R.S. §35-393:

either:

the fact that the entity does business in Israel or in territories controlled 'srael. ^ of nationality, national origin or religion and that is

(a) Based in part on

(b) In a manner that discriminates on the basis not based on a valid business reason.

2. "Company” means an organization partnership, limited liability company r. .4 ton nr owned subsidiary, parent company or affiliate, that engages in for-profit activity and that has association, corporation, partnership, joint venture, limited partnership, ^mited liability other entity or business association, including a wholly owned subsidiary, majority more full-time employees.

or

, board, commission or department of this State

5. "Public entity" means this State, a political subdivision of this State or an agency political subdivision ofthis State.

The certification below does not pursuant to that section. See A.R.S. §35-393.03.

In compliance with A.R.S. §§35-393 etseq., all offerors must select one of the following:

or a regulation issued include boycotts prohibited by 50 United States Code Section 4842 or a

; not to participate in during the term of the . 1 understand that my entire response willThe Company submitting this Offer does not participate in, and agrees contract, a boycott of Israel in accordance with A.R.S. §§35-393 etsep.

become public record in accordance with A.A.C. R2-7-C317.

The Company submitting this Offer do« participate in a boycott of Israel as

¥l described in A.R.S. §§35-393 etseq.

Exempt Solicitation, Contract, or Contractor.

Indicate which of the following statements applies to this Contract:

□ Solicitation or Contract has an estimated value of less than $100,000;

□ Contractor is a sole proprietorship;

□ Contractor has fewer than ten (10) employees; and/or

□ Contractor is a non-profit organization.

(hihsibr\ Cjnkr ! Company Name

/J. oT

Rcfized to SignSign!

Printed Name Address

Title ZipState

City

Page 1 of 1Available online at nttD5://aDD.az.go_y Solicitation No: BPM006654