2-Attachment D-Scrutinized Companies.pdf
PDF 185 KB Posted
- Attached to
- South Machine Room Booster Pump
- Solicitation number
- PROJ-26-068
- Issued by
- Volusia County, Florida
About this file
This is a vendor certification form for Halifax Health, a Florida-based government entity, regarding compliance with state scrutinized companies legislation. The form requires vendors bidding on Halifax Health contracts to certify their compliance status with Florida Statutes sections 287.135 and 215.4725. The certification applies to all contract amounts for companies on the Scrutinized Companies that Boycott Israel List or engaged in boycotts of Israel. For contracts exceeding one million dollars, the certification also addresses compliance regarding the Scrutinized Companies with Activities in Sudan List, the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, and business operations in Cuba or Syria. The form collects vendor identification information including name, Federal Employer Identification Number (FEIN), authorized representative details, address, contact information, and requires a signed certification by an authorized company representative.
Vendors must affirm under penalty of law that their company is not listed on any of the prohibited scrutinized companies lists and is not engaged in the specified business activities or boycotts. Submission of false certification subjects vendors to civil penalties, attorney's fees, and costs. Halifax Health reserves the right to terminate any contract if a vendor submits false certification or is subsequently found to be listed on prohibited lists or engaged in prohibited activities. For contracts valued at one million dollars or more, termination rights extend to violations related to Sudan activities, Iran petroleum sector activities, and operations in Cuba or Syria. This certification requirement applies to the South Machine Room Booster Pump project, which involves removal and replacement of existing booster pumps.
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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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