2-Attachment D-Scrutinized Companies.pdf
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- Attached to
- Twin Lakes SSPD Equipment Replacement
- Solicitation number
- PROJ-25-134
- Issued by
- Volusia County, Florida
About this file
This document is a vendor certification form (Attachment D) required by Halifax Health regarding scrutinized companies under Florida Statutes. The form requires vendors to certify that their company is not listed on various scrutinized company lists and is not engaged in boycotts of Israel or business operations in certain countries including Cuba and Syria. Vendors must provide their company information including name, FEIN, authorized representative details, address, and contact information, along with a signed certification from an authorized representative.
The certification is governed by Florida Statutes Section 287.135, which prohibits companies from bidding on or entering into contracts of any amount if they are on the Scrutinized Companies that Boycott Israel List or engaged in boycotting Israel. For contracts over one million dollars, additional restrictions apply to companies on the Scrutinized Companies with Activities in Sudan List or Iran Petroleum Energy Sector List, or those engaged in business operations in Cuba or Syria. False certification may result in civil penalties, attorney's fees, costs, and potential contract termination at Halifax Health's option, with specific termination provisions varying based on contract value and the nature of any violations.
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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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