12-Scrutinized Companies Form.pdf
PDF 600 KB Posted
- Attached to
- Marine Resource Assessment & Monitoring Services
- Solicitation number
- RFQ No. 2026-008
- Issued by
- Palm Beach County, Florida
About this file
This is a Scrutinized Company Certification form required by the Town of Palm Beach Purchasing Division for vendors and contractors seeking to do business with the municipality in Florida. The form serves as a compliance document for the Marine Resource Assessment & Monitoring Services solicitation, wherein the Town of Palm Beach seeks qualifications from biological and environmental assessment and monitoring consultants to support the Town's Coastal Management Plan activities. The Town accepts online submissions exclusively through the Euna Procurement (Bonfire) platform, and proposers are bound to their submissions for one hundred eighty days from the opening date. A non-mandatory pre-proposal conference will be conducted virtually via Microsoft Teams, with attendance strongly encouraged as the sole opportunity for direct clarification from Town staff. Award will be made to the proposer offering the best value, and the Town reserves the right to reject any and all proposals or re-advertise for all or any portion of the solicitation.
The certification form requires vendors to affirm under oath that their company is not listed on any Scrutinized Companies list pursuant to Florida Statutes 215.4725, 215.473, or 287.135. Specifically, vendors must certify that they are not participating in boycotts of Israel; do not appear on the Scrutinized Companies with Activities in Sudan List based on material business relationships with Sudan's government or involvement in oil, mineral extraction, power generation, military equipment supply, or genocidal activities; do not appear on the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List involving material business relationships with Iran's government or material investments in Iran's petroleum sector; and are not engaged in business operations in Cuba or Syria. The form requires completion with vendor company name, individual name, title, signature, and date, and must be submitted as part of the proposal package.
View the file
Other files
Show all 16
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .