14._Iran_Contracting_Act_E-Signature.pdf

The document is an Iran Contracting Act Verification Form from the State of California's Department of General Services Procurement Division, designed for vendors participating in state contracts. The form requires vendors bidding on contracts valued at $1,000,000 or more to certify that they are not currently engaged in investment activities in Iran, either directly or through a financial institution extending credit. Vendors must complete one of two options: Option #1 involves certifying they are not on the current list of persons engaged in Iranian investment activities, or Option #2 allows for requesting an exemption on a case-by-case basis under specific Public Contract Code sections.

The form outlines significant legal penalties for providing false certifications, including potential civil penalties up to $250,000, contract termination, and three-year bidding ineligibility. The verification is part of California's legal framework prohibiting state contracts with entities conducting business in Iran's energy sector, with the DGS maintaining a current list of prohibited vendors. Vendors must provide their name, financial institution details, and Federal ID Number when completing the form, with the document serving as a mandatory compliance mechanism for state procurement processes.