2-Attachment D-Scrutinized Companies.pdf
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- Attached to
- France Tower Lobby Area Window Tint
- Solicitation number
- PROJ-25-132
- Issued by
- Volusia County, Florida
About this file
This is a vendor certification form (Attachment D) required by Halifax Health for companies bidding on or entering into contracts for goods or services. The form mandates that vendors certify their compliance with Florida Statutes Section 287.135, which prohibits companies from contracting if they are on specified scrutinized company lists or engaged in boycotts of Israel. For contracts of any amount, companies cannot be on the Scrutinized Companies that Boycott Israel List or engaged in boycotting Israel, while contracts over one million dollars have additional restrictions regarding companies with activities in Sudan or Iran's petroleum energy sector, or those engaged in business operations in Cuba or Syria.
The certification requires vendors to provide complete company information including name, FEIN, authorized representative details, and contact information, followed by an attestation that they are not listed on any of the prohibited lists and are not engaged in restricted activities. Vendors must understand that submitting false certifications may result in civil penalties, attorney's fees, and costs, and that Halifax Health may terminate contracts if false certifications are discovered or if the company is subsequently placed on restricted lists. The form requires an authorized representative's signature, printed name, title, and date to complete the certification process.
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Text version
Attachment D
VENDORS CERTIFICATION REGARDING SCRUTINIZED COMPANIES
Vendor Name: ________________________________________________________________
Vendor FEIN: __________________________________
Vendors Authorized Representative Name and Title: ___________________________________
Address: _____________________________________________________________________
City: ___________________________________ State: ___________ Zip: ______________
Telephone Number: ____________________________
Email Address: ________________________________________________________________
Section 287.135(2)(a), Florida Statutes, prohibits a company from bidding on, submitting a proposal for, or entering into or renewing a contract for goods or services of any amount if, at the time of contracting or renewal, the company is on the Scrutinized Companies that Boycott Israel List, created pursuant to § 215.4725, Florida Statutes, or is engaged in a boycott of Israel.
Section 287.135(2)(b), Florida Statutes, further prohibits a company from bidding on, submitting a proposal for, or entering into or renewing a contract for goods or services over one million dollars ($1,000,000) if, at the time of contracting or renewal, the company is on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, both created pursuant to § 215.473, Florida Statutes, or the company is engaged in business operations in Cuba or Syria.
As the person authorized to sign on behalf of the Vendor, I hereby certify that the company identified in the Section entitled “Vendor Name” above is not listed on any of the following: (i) the Scrutinized Companies that Boycott Israel List, (ii) Scrutinized Companies with Activities in Sudan List, or (iii) the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List. I further hereby certify that the company identified above is not engaged in a boycott of Israel or engaged in business operations in Cuba or Syria. I understand that pursuant to § 287.135, Florida Statutes, the submission of a false certification may subject the company to civil penalties, attorney’s fees, and/or costs. I further understand that any contract with Halifax Health for goods or services of any amount may be terminated at the option of Halifax Health if the company (i) is found to have submitted a false certification, (ii) has been placed on the Scrutinized Companies that Boycott Israel List, or (iii) is engaged in a boycott of Israel. And, in addition to the foregoing, if the amount of the contract is one million dollars ($1,000,000) or more, the contract may be terminated at the option of Halifax Health if the company is found to have submitted a false certification, has been placed on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or has been engaged in business operations in Cuba or Syria.
Signature of Authorized Representative: ___________________________________________
Printed Name: _____________________________________________ Date:_____________
Title of Authorized Representative: ________________________________________________
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