2-Attachment B-Bidders Cert.pdf
PDF 1 MB Posted
- Attached to
- Water Heater for OBCC
- Solicitation number
- PROJ-25-148
- Issued by
- Volusia County, Orlando City, 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 bidders to certify compliance with multiple legal and ethical standards, including receiving a complete set of bid papers, affirming no collusion or unethical practices, complying with equal opportunity employment practices, having an adopted sexual harassment policy, and agreeing to abide by federal, state, and local regulations.
The certification form requires bidders to confirm they are not barred from contracting with local government units in Florida due to tax delinquencies, and includes provisions for the bidder's executing officer to attest to the truthfulness of their statements. The document includes spaces for company name, address, contact information, and signature lines for an authorized company official, with a notarization section to formally validate the bidder's declarations. The form is dated for the year 2024 and is part of a standard procurement process for soliciting bids from potential contractors.
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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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