2-Attachment D-Scrutinized Companies.pdf
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- Attached to
- PHARMACY IV ROOM REMODEL FOR HHPO
- Solicitation number
- PROJ-25-099
- Issued by
- Volusia County, Florida
About this file
This is a vendor certification form (Attachment D) for Halifax Health requiring companies to certify their compliance with Florida Statutes regarding scrutinized companies. The form requires vendors to provide basic company information including name, FEIN, authorized representative details, and contact information, and must be completed by companies seeking to bid on, submit proposals for, or enter into contracts with Halifax Health for goods or services.
The certification addresses Florida Statutes Section 287.135, which prohibits companies from contracting if they appear on specific scrutinized company lists or engage in certain boycotts or business operations. Companies must certify they are not on the Scrutinized Companies that Boycott Israel List, are not engaged in boycotting Israel, and for contracts over $1,000,000, must additionally certify they are not on the Scrutinized Companies with Activities in Sudan List or Iran Petroleum Energy Sector List, nor engaged in business operations in Cuba or Syria. Halifax Health reserves the right to terminate contracts if false certifications are submitted or if companies are subsequently placed on these lists, with potential civil penalties, attorney's fees, and costs for submitting false certifications.
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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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