13-Exhibit 11 to Specifications - Iran Free Procurement Certification Form.pdf
PDF 96 KB Posted
- Attached to
- Sodim Chloride (Bulk Road Salt)
- Solicitation number
- 6100045971
- Issued by
- Beaver County, Pennsylvania
About this file
This document is an Iran Free Procurement Certification Form required for vendors seeking to contract with the Commonwealth of Pennsylvania for goods or services worth at least $1,000,000 or more. The certification form requires vendors to either certify they are not on the list of persons engaged in investment activities in Iran, or demonstrate they have received an exemption from the certification requirement. The form outlines the penalties for providing false certifications, including civil penalties, contract termination, and a three-year ineligibility to bid on contracts. Two options are provided for vendors to complete the certification: Option #1 for certification of not being on the Iran investment list, and Option #2 for demonstrating an exemption has been obtained.
The certification form does not provide any details about a specific contract opportunity, but rather outlines the requirements for all vendors seeking to contract with the Commonwealth of Pennsylvania for goods or services valued at $1,000,000 or more. There are no details included about the products or services being procured, response dates, award information, or contract term.
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Text version
BOP-1701
Published: 1/26/2017
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
EXHIBIT 11
IRAN FREE PROCUREMENT CERTIFICATION FORM
(Pennsylvania’s Procurement Code Sections 3501-3506, 62 Pa.C.S. §§ 3501-3506)
| IRAN FREE PROCUREMENT CERTIFICATION FORM |
| (Pennsylvania’s Procurement Code Sections 3501-3506, 62 Pa.C.S. §§ 3501-3506) |
| OPTION #1 - CERTIFICATION |
| OPTION #2 – EXEMPTION |
File details come from the government source that posted it. Updated .