2-Attachment D-Scrutinized Companies.pdf
PDF 185 KB Posted
- Attached to
- SEVCC CU3&CU6 Replacements
- Solicitation number
- PROJ-26-027
- Issued by
- Volusia County, Florida
About this file
This is a vendor certification document required by Halifax Health, a Florida-based healthcare organization, for participation in the SEVCC CU3&CU6 Replacements contract opportunity. The document serves as a compliance certification form that vendors must complete and submit as part of their bid proposal. Contractors bidding on this project to replace air-cooled condensing units at Halifax Hospice's Southeast Volusia Care Center must provide their company information, including vendor name, FEIN, authorized representative details, address, and contact information on the certification form.
The certification requires vendors to attest that their company is not listed on any Florida scrutinized company lists related to Israel boycotts, Sudan activities, or Iran petroleum energy sector activities, and that the company is not engaged in boycotts of Israel or business operations in Cuba or Syria. Vendors must acknowledge that submission of false certification may result in civil penalties, attorney's fees, and costs, and that Halifax Health may terminate any resulting contract if the vendor is found to have submitted false information or subsequently appears on prohibited lists. For contracts valued at one million dollars or more, additional termination provisions apply regarding Sudan, Iran, Cuba, and Syria activities. The authorized representative must sign and date the certification, affirming compliance with all requirements under Florida Statutes sections 287.135 and 215.4725.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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: ________________________________________________
| Text1: |
| Text2: |
| Text3: |
| Text4: |
| Text5: |
| Text6: |
| Text7: |
| Text8: |
| Text9: |
| Text10: |
| Text11: |
| Text12: |
| Text13: |
File details come from the government source that posted it. Updated .