Vendor Certification - Compliance with Federal Anti-Discrimination Law.pdf
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- Solicitation number
- 19AS2025Q0012
- Issued by
-
Department of State US Embassy Canberra
About this file
This document is a Vendor Certification form for compliance with Federal Anti-Discrimination Law, issued by the U.S. Embassy in Canberra, Australia. The certification requires contractors to affirm they are in compliance with all applicable federal anti-discrimination laws and do not operate any Diversity, Equity, and Inclusion (DEI) programs that violate these laws. The form is specifically related to a pre-solicitation for Workers Compensation Insurance (Solicitation Number 19AS2025Q0012) covering U.S. Embassy Canberra employees for the period of July 1st, 2025 - June 30th, 2026. Contractors must complete the form by checking the appropriate compliance boxes, providing company and authorized representative details, and returning it to the Contracting Officer, with the understanding that false certification could be subject to the False Claims Act.
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Embassy of the United States of America Canberra, Australia
CERTIFICATION REGARDING COMPLIANCE WITH APPLICABLE
FEDERAL ANTI- DISCRIMINATION LAW
All Department of State contractors must certify that they do not operate any programs promoting DEI that violate any applicable anti-discrimination laws and agree that such certification is material for purposes of the government’s payment decision and therefore subject to the False Claims Act. See 31 U.S.C. 3729(b)(4).
DIRECTIONS FOR CONTRACTORS and/or OFFERORS
1. Read the entire certification provided below.
2. After you have read the provisions, please check the appropriate boxes.
3. Upon completion of Step 2, fill out the representation below. NOTE:
This certification is made by a person with the authority to bind the contractor or offeror.
4. Return completed form to the Contracting Officer/POC shown in the e-mail.
CERTIFICATION:
The Contractor or prospective offeror certifies they:
☐ are in compliance in all respects with all applicable Federal anti-discrimination laws is material to the government’s payment decisions for purposes of section 31 USC 3729(b)(4) (False Claims Act); and
☐ do not operate any programs promoting Diversity, Equity, and Inclusion that violate any applicable Federal anti-discrimination laws.
Contractor or Offeror Name (Printed or Typed):
Authorized Representative Name and Title:
Authorized Representative Signature and Date:
| CERTIFICATION REGARDING COMPLIANCE WITH APPLICABLE FEDERAL ANTI- DISCRIMINATION LAW |
| DIRECTIONS FOR CONTRACTORS and/or OFFERORS |
| CERTIFICATION: |
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