10-Attachment B-Bidders Cert.pdf
PDF 119 KB Posted
- Attached to
- HBS RTU REPLACEMENTS
- Solicitation number
- PROJ-26-073
- Issued by
- Volusia County, Florida
About this file
This is a Bidder's Certification form for Halifax Health Medical Center, a Florida-based healthcare facility, for ITB #PROJ-26-073 related to HBS RTU Replacements. The project involves replacement of four rooftop units (RTUs: Unit 11, 12, 13, and 14) at Halifax Health Behavioral Services. Bidders submitting proposals must complete and submit this certification form as part of their bid package, affirming that they have received complete bid documents and agree to comply with all terms and conditions contained therein.
The certification requires bidders to confirm compliance with federal, state, and local laws regarding equal opportunity employment practices, possess a written sexual harassment policy in accordance with applicable regulations, and certify they have not engaged in collusion or unethical practices. Bidders must also provide tax certification through a sworn statement from the bidder's executing officer, confirming that the bidder is not barred from contracting with any Florida local government unit due to tax delinquency with the Florida Department of Revenue, unless the bidder is actively contesting such liability through appropriate statutory procedures. The form requires the bidder's company name, address, authorized official signature, title, contact information, and notarization by a notary public.
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Text version
ATTACHMENT B
HALIFAX HEALTH MEDICAL CENTER
BIDDER’S CERTIFICATION
ITB # PROJ-26-073
I/We hereby certify that:
A. A complete set of bid papers, as intended, has been received, and I/We will abide by the contents and/or information received and/or contained herein.
B. I/We have not entered into any collusion or other unethical practices with any person, firm, or employee of the District which would in any way be construed as unethical practice.
C. I/We comply with all current federal, state and local laws, statutes, rules, and regulations referencing equal opportunity employment practices.
D. I/We have adopted a written sexual harassment policy which is in accordance with the requirements of federal, state and local laws, regulations and policies.
E. I/We will abide by all other federal, state and local codes, rules, regulations, ordinances and statutes.
COMPANY NAME
ADDRESS
DISTRICT/STATE/ZIP CODE
NAME OF CORPORATE/COMPANY OFFICIAL
(PLEASE TYPE OR PRINT CLEARLY)
TITLE
AUTHORIZED OFFICIAL SIGNATURE
DATE
TELEPHONE ( )
HALIFAX HEALTH MEDICAL CENTER
STATE OF FLORIDA
ITB # PROJ-26-073
COUNTY OF
BIDDER’S TAX CERTIFICATION
(BIDDER’S EXECUTING OFFICER), being first duly sworn on oath, deposes and states that all statements made herein are made on behalf of the Bidder, that this respondent is authorized to make them and that the statements contained herein are true and correct. Bidder deposes, states and certifies that Bidder is not barred from contracting with any unit of local government in the State of Florida as result of a delinquency in payment of any tax administered by the Florida Department of Revenue unless Bidder is contesting, in accordance with the procedures established by the appropriate statute, its liability for the tax or the amount of the tax.
DATED this day of , 2026.
By (Bidder’s Executing Officer)
(Name of Bidder’s Executing Officer)
(Title)
ATTEST/WITNESS:
By
Title
Subscribed and sworn to before me this day of , 2026.
Notary Public
(SEAL)
File details come from the government source that posted it. Updated .