12-Scrutinized Companies Form.pdf
PDF 600 KB Posted
- Attached to
- Moving Services
- Solicitation number
- RFB No. 2026-017
- Issued by
- Palm Beach County, Florida
About this file
This is a Scrutinized Company Certification form issued by the Town of Palm Beach, Florida Purchasing Division in connection with a moving services solicitation. The document requires vendors to certify compliance with Florida statutes regarding business activities in specified countries and regions. The Town of Palm Beach is requesting competitive bids from qualified contractors to provide moving services within Palm Beach County, including labor, equipment, and vehicles necessary for relocating equipment and furnishings used in governmental offices and facilities, as well as monthly pickup of surplus items. Items to be moved include desks, chairs, tables, filing cabinets, recreational equipment, information technology equipment, and miscellaneous items. The successful vendor must employ only direct employees with no contract labor or subcontracting permitted without written Town approval. A non-mandatory pre-bid meeting will be held virtually via Microsoft Teams, with specific details provided in the solicitation events section. Award will be made to the lowest responsive bidder meeting the stated requirements.
The certification form requires vendors to affirm under penalty of perjury that their company does not appear on any Scrutinized Companies lists created under Florida Statutes 215.4725, 215.473, or 287.135, and specifically certifies that the company is not participating in boycotts of Israel, does not have material business relationships with the governments of Sudan or Iran involving petroleum or mineral extraction activities, is not engaged in military equipment supply to sanctioned entities, and is not conducting business operations in Cuba or Syria. The form must be signed by an authorized representative of the vendor company and submitted as part of the bid package through the Town's online eProcurement platform, Euna Procurement (Bonfire). All personnel performing Town tasks are required to wear company-identified uniforms, with employee name tags preferred.
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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 .