2-Attachment B-Bidders Cert.pdf
PDF 1 MB Posted
- Attached to
- Water Heater for SEVCC
- Solicitation number
- PROJ-25-149
- Issued by
- Volusia County, Florida
About this file
This document is a Bidders Certification and Tax Certification form for Halifax Health Medical Center, associated with Invitation to Bid (ITB) # PROJ-25-002 for the State of Florida. The form requires potential bidders to certify several key compliance points, including receipt of bid documents, non-collusion, adherence to equal opportunity employment practices, possession of a sexual harassment policy, and commitment to federal, state, and local regulations.
The certification requires bidders to confirm they are not barred from contracting with local government units in Florida due to tax delinquencies, and mandates that the executing officer swear to the truthfulness of all statements. The document provides space for company details, contact information, authorized signatures, and requires notarization, suggesting this is a formal pre-qualification document for potential vendors or contractors seeking to do business with Halifax Health Medical Center.
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Text version
ATTACHMENT B
HALIFAX HEALTH MEDICAL CENTER
BIDDERS CERTIFICATION
ITB # PROJ-25-002
I/We hereby certify that:
A. A complete set of bid papers, as intended, has been received, and I/We will abide by the contents and/or information received and/or contained herein.
B. I/We have not entered into any collusion or other unethical practices with any person, firm, or employee of the District which would in any way be construed as unethical practice.
C. I/We comply with all current federal, state and local laws, statutes, rules, and regulations referencing equal opportunity employment practices.
D. I/We have adopted a written sexual harassment policy which is in accordance with the requirements of federal, state and local laws, regulations and policies.
E. I/We will abide by all other federal, state and local codes, rules, regulations, ordinances and statutes.
COMPANY NAME
ADDRESS
DISTRICT/STATE/ZIP CODE
NAME OF CORPORATE/COMPANY OFFICIAL
(PLEASE TYPE OR PRINT CLEARLY)
TITLE
AUTHORIZED OFFICIAL SIGNATURE
DATE
TELEPHONE ( )
HALIFAX HEALTH MEDICAL CENTER
STATE OF FLORIDA
ITB # PROJ-25-002
COUNTY OF
BIDDER’S TAX CERTIFICATION
(BIDDER’S EXECUTING OFFICER), being first duly sworn on oath, deposes and states that all statements made herein are made on behalf of the Bidder, that this respondent is authorized to make them and that the statements contained herein are true and correct. Bidder deposes, states and certifies that Bidder is not barred from contracting with any unit of local government in the State of Florida as result of a delinquency in payment of any tax administered by the Florida Department of Revenue unless Bidder is contesting, in accordance with the procedures established by the appropriate statute, its liability for the tax or the amount of the tax.
DATED this day of , 2024.
By (Bidder’s Executing Officer)
(Name of Bidder’s Executing Officer)
(Title)
ATTEST/WITNESS:
By
Title
Subscribed and sworn to before me this day of , 2024.
Notary Public
(SEAL)
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