14._Iran_Contracting_Form.pdf

This document is an Iran Contracting Act Verification Form from the California Department of General Services Procurement Division for Solicitation Number 25CRW018. The form requires vendors or financial institutions bidding on a State of California contract for services valued at $1,000,000 or more to certify their status regarding investment activities in Iran. Vendors must either confirm they are not on the current list of persons engaged in Iranian investment activities or demonstrate they have been exempted from the certification requirement.

The form provides two options for compliance: Option #1 allows vendors to certify they are not on the list of persons engaged in Iranian investment activities, and Option #2 permits vendors to seek an exemption on a case-by-case basis. California law establishes significant penalties for providing false certifications, including civil penalties up to $250,000, contract termination, and three-year ineligibility to bid on contracts. Vendors must complete the form by inserting their name, Federal ID Number, and an authorized signature, with the understanding that providing accurate information is crucial for contract eligibility.