10-Scrutinized Companies Form.pdf
PDF 600 KB Posted
- Attached to
- Palm Tree Trimming and Pruning Services State and local contract opportunity
- Solicitation number
- ITB No. 2026-028
- Issued by
- Palm Beach County, Florida
About this file
This is a Scrutinized Company Certification Form submitted to the Town of Palm Beach Purchasing Division in connection with a Palm Tree Trimming and Pruning Services contract opportunity. The form requires vendors to certify their compliance with Florida statutory requirements regarding international business practices and sanctions. Bidders must affirm that their company does not participate in boycotts of Israel, does not appear on state scrutinized company lists related to Sudan, Iran's petroleum sector, or the Iran Petroleum Energy Sector List, and does not conduct business operations in Cuba or Syria. The certification is executed under oath and references Florida Statutes 215.4725, 215.473, and 287.135.
The form serves as a mandatory compliance document for all vendors seeking to contract with the Town of Palm Beach. Vendors must complete the form by providing their company name, signatory name and title, signature, and date. The certification affirms current compliance status as of the execution date and is a prerequisite for bid submission. Failure to complete and submit this certification would likely render a bid non-responsive to the Town's invitation to bid requirements for tree trimming and pruning services.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| 7-Protest Procedure Form.pdf | ||
| 13-Sample Tree Trimming Spring Schedule.pdf | ||
| 4-E-Verify Form.pdf | ||
| 11-Drug Free Workplace Form.pdf | ||
| 14-Town Map.pdf | ||
| 5-FS 119.0701 and FS 119.071 for Public Records 2024 version.pdf | ||
| 15-EQUIPMENT LIST FORM.pdf | ||
| 8-Reference Form.pdf | ||
| 2-Bidder’s Qualification Form.pdf | ||
| 19-Bonds Requirements Form Surety2000.pdf | ||
| 20-Public Bid Opening ITB No. 2026-028.pdf | ||
| 12-ITB revised - Terms and Conditions - Goods and Services.pdf | ||
| 17-ITB No. 2026-028 - Palm Tree Trimming - Location List.pdf | ||
| 18-SOW - ITB No. 2026-028.pdf | ||
| 6-Minimum Qualification Form.pdf | ||
| 1-Affidavit of Compliance with Foreign Entity and Human Trafficking.pdf | ||
| 21-Pre-Bid Meeting ITB No. 2026-028.pdf | ||
| 16-3-9 Trimming Rule.pdf | ||
| 3-Contact Info Form.pdf | ||
| 9-Insurance Requirements - Risk Type 1 - Standard Contracts.pdf |
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Text version
11/16/18
Scrutinized Company Certification
1. This company is not participating in a boycott of Israel such that it is not refusing to deal, terminating business activities, or taking other actions to limit commercial relations with Israel, or persons or entities doing business in Israel or in Israeli-controlled territories, in a discriminatory manner.
2. This Company does not appear on the Scrutinized Companies with Activities in Sudan List where the
State Board of Administration has established the following criteria:
a. Have a material business relationship with the government of Sudan or a government-created project involving oil related, mineral extraction, or power generation activities, or
b. Have a material business relationship involving the supply of military equipment, or
c. Impart minimal benefit to disadvantaged citizens that are typically located in the geographic periphery of Sudan, or
d. Have been complicit in the genocidal campaign in Darfur.
3. This Company does not appear on the Scrutinized Companies with Activities in the Iran Petroleum
Energy Sector List where the State Board of Administration has established the following criteria:
a. Have a material business relationship with the government of Iran or a government-created project involving oil related or mineral extraction activities, or
b. Have made material investments with the effect of significantly enhancing Iran‘s petroleum sector.
4. This Company is not engaged in business operations in Cuba or Syria.
VENDOR/COMPANY NAME:
NAME:
TITLE:
SIGNATURE:
DATE:
TOWN OF PALM BEACH
PURCHASING DIVISION
951 Okeechobee Road Suite D West Palm Beach, Florida 33401
Telephone: (561) 838-5406
PURCHASING DIVISION
951 Okeechobee Road Suite D West Palm Beach, Florida 33401
Telephone: (561) 838-5406 Facsimile (561) 835-4688 Website: www.townofpalmbeach.com
I hereby swear or affirm that as of the date below this company is not listed on a Scrutinized Companies list created pursuant to 215.4725, 215.473, or 287.135, Florida Statutes. Pursuant to 287.135, Florida Statutes I further affirm that:
http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0200-0299/0215/Sections/0215.4725.html http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0200-0299/0215/Sections/0215.4725.html http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0200-0299/0287/Sections/0287.135.html
| VENDORCOMPANY NAME: |
| Name: |
| Title: |
| Signiture: |
| Date: |
File details come from the government source that posted it. Updated .