11 IranFreeProcurementCertificationForm.pdf
PDF 29 KB Posted
- Attached to
- Allegheny OVR Enhanced Driving/Anc Svcs
- Solicitation number
- 6100066394-1
- Issued by
- Allegheny County, Philadelphia City, Pennsylvania
About this file
This is an Iran Free Procurement Certification Form required by the Commonwealth of Pennsylvania under Sections 3501-3506 of the Procurement Code, applicable to the Department of Labor and Industry's Office of Vocational Rehabilitation for the Allegheny County Enhanced Driving and Ancillary Services contract opportunity. The form establishes eligibility requirements for vendors seeking to contract with Commonwealth entities for goods or services valued at $1,000,000 or more. Vendors must either certify they are not on the current list of persons engaged in investment activities in Iran maintained by the Pennsylvania Department of General Services, or demonstrate they have received a written exception from the certification requirement on a case-by-case basis under Section 3503(e) of the Procurement Code.
The certification requirement is mandatory for contract award eligibility. Pennsylvania law imposes substantial penalties for false certifications, including civil penalties equal to the greater of $250,000 or twice the contract amount, contract termination, and a three-year suspension from bidding on Commonwealth contracts. Vendors must complete either Option #1 (standard certification) or Option #2 (exemption documentation) and provide authorized signatures with printed names, titles, and execution dates. The form is issued under authority of the Pennsylvania Procurement Code and applies to all vendors regardless of business size or classification seeking contracts with Commonwealth entities meeting the dollar threshold.
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Text version
BOP-1701
Published: 1/26/2017
IRAN FREE PROCUREMENT CERTIFICATION FORM
(Pennsylvania’s Procurement Code Sections 3501-3506, 62 Pa.C.S. §§ 3501-3506)
To be eligible for an award of a contract with a Commonwealth entity for goods or services worth at least $1,000,000 or more, a vendor must either: a) certify it is not on the current list of persons engaged in investment activities in Iran created by the Pennsylvania Department of General Services (“DGS”) pursuant to Section 3503 of the Procurement Code and is eligible to contract with the Commonwealth under Sections 3501-3506 of the Procurement Code; or b) demonstrate it has received an exception from the certification requirement for that solicitation or contract pursuant to Section 3503(e).
To comply with this requirement, please insert your vendor or financial institution name and complete one of the options below. Please note: Pennsylvania law establishes penalties for providing false certifications, including civil penalties equal to the greater of $250,000 or twice the amount of the contract for which the false certification was made; contract termination; and three-year ineligibility to bid on contracts. (Section 3503 of the Procurement Code.)
OPTION #1 - CERTIFICATION
I, the official named below, certify I am duly authorized to execute this certification on behalf of the vendor/financial institution identified below, and the vendor/financial institution identified below is not on the current list of persons engaged in investment activities in Iran created by DGS and is eligible to contract with the Commonwealth of Pennsylvania Sections 3501-3506 of the Procurement Code.
Vendor Name/Financial Institution (Printed)
By (Authorized Signature)
Printed Name and Title of Person Signing Date Executed
OPTION #2 – EXEMPTION
Pursuant to Procurement Code Section 3503(e), DGS may permit a vendor/financial institution engaged in investment activities in Iran, on a case-by-case basis, to enter into a contract for goods and services.
If you have obtained a written exemption from the certification requirement, please fill out the information below, and attach the written documentation demonstrating the exemption approval.
Vendor Name/Financial Institution (Printed)
By (Authorized Signature)
Printed Name and Title of Person Signing Date Executed
| IRAN FREE PROCUREMENT CERTIFICATION FORM |
| (Pennsylvania’s Procurement Code Sections 3501-3506, 62 Pa.C.S. §§ 3501-3506) |
| OPTION #1 - CERTIFICATION |
| OPTION #2 – EXEMPTION |
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