2.1 Attachment 15 - Antimafia screening attachments.pdf
PDF 101 KB Posted
- Attached to
- V301 - Personal Property Shipments (Direct Procurement Method) - Naples Federal contract opportunity
- Solicitation number
- N6817126QN003
About this file
This document contains two Italian anti-mafia self-certification forms required for contract participation under Legislative Decree 06/09/2011 n.159, Article 85.
Attachment N.1: Self-Certification of Anti-Mafia Communication requires the declarant to certify that no causes of prohibition, forfeiture, or suspension exist under Article 57 of Legislative Decree 06/09/2011 n.159. The form requests the declarant's last name, first name, date and place of birth, fiscal code or VAT number, and place of residence. The signatory must acknowledge criminal liability for false declarations under Articles 75 and 76 of Presidential Decree 445 (28 December 2000) and confirm understanding of data protection requirements under Legislative Decree 196/2003. A copy of the subscriber's identity document must be provided. The declaration does not require signature authentication and serves as a replacement for standard certifications required by public administration and managers of public services.
Attachment N.2: Self-Certification of Anti-Mafia Information requires similar personal identification information and certifies that no causes of prohibition, forfeiture, or suspension exist under Article 67 of Legislative Decree 06/09/2011 n.159 for the declarant and any cohabiting family members aged 18 or older. This form includes a table for listing family member details (first name, last name, date of birth, place of birth, and fiscal code). Like Attachment N.1, it requires acknowledgment of criminal liability for false statements, confirmation of data protection compliance, a signature, and a copy of the subscriber's identity document.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 2.8 Amend 0001 - Q&A.pdf | ||
| 2.8 N6817126QN0030001.pdf | ||
| 2.1 Attachment 14 - Bundle Pricing.xlsx | XLSX spreadsheet | |
| 2.1 Attachment 10 - Appendix E - DD Form 1812 Warehouse Inspection Guide.pdf | ||
| 2.1 Attachment 8 - PWS Attachment A-G-7.pdf | ||
| 2.1 Attachment 4 - PWS Attachment A-G-3.pdf | ||
| 2.1 Attachment 11 - Attachment E-1 - FIRE PREVENTION WAREHOUSE INSPECTIONS.pdf | ||
| 2.1 Attachment 7 - PWS Attachment A-G-6.pdf | ||
| 2.1 Attachment 6 - PWS Attachment A-G-5.pdf | ||
| 2.1 Attachment 2 - PWS Attachment A-G-1.pdf | ||
| 2.1 Attachment 1 - PWS Appendix A-G.pdf | ||
| 2.1 Attachment 3 - PWS Attachment A-G-2.pdf | ||
| 2.1 RFQ N6817126QN003.pdf | ||
| 2.3 Attachment 13 - QASP.docx | DOCX document | |
| 2.2 Attachment 12 - CAP.pdf | ||
| 2.1 Attachment 9 - Appendix D - DD Form 1811 Pre-Award Survey Guidelines.pdf | ||
| 2.1 Attachment 5 - PWS Attachment A-G-4.pdf |
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Text version
ATTACHMENT N.1
SELF-CERTIFICATION OF THE ANTI-MAFIA COMMUNICATION
(Art. 85 of Legislative Decree 06/09/2011 n.159)
The undersigned (Last name, Name) ______________________________________________________________ Date and place of Birth FISCAL CODE or VAT Number Place of residence Prov.
Street_____________________________________________________n•_____________
Fully aware of the criminal liability faced, pursuant to and by effect of articles 75 and 76 of the Presidential Decree 28 December 2000, n• 445, in case of false declarations or creation, exhibition or use of false documents, or documents containing data no longer corresponding to the truth, declares and attests under his/her own responsibility:
That the causes of prohibition, forfeiture or suspension pursuant to art. 57 of Legislative Decree 06/09/2011 n• 159 are not present.
The undersigned also declares to be fully informed, pursuant to Legislative Decree No. 196/2003 (Code regarding the protection of personal data), that the data collected will be processed, even with IT tools, exclusively within the purpose of the procedure for which this declaration is made.
Date
Signature
Provide copy of the Identity document of the subscriber.
This declaration does not require the authentication of the signature and replaces, for all the intents and purposes, the normal certifications required by a Public Administration, as well as for managers of public services and the private sector who allow it.
Legislative Decree 06/09/2011 n. 159, art. 85 https://def.finanze.it/DocTribFrontend/decodeurn?urn=urn:doctrib::DLG:2011-09-06;159_art85
Attachment 1
ATTACHMENT N.2
SELF-CERTIFICATION OF THE ANTI-MAFIA INFORMATION
(Art. 85 of Legislative Decree 06/09/2011 n.159)
The undersigned (Last name, Name) ______________________________________________________________ Date and place of Birth FISCAL CODE or VAT Number _ Place of residence Prov.
Street_____________________________________________________________________n•____
Fully aware of the criminal liability faced, pursuant to and by effect of articles 75 and 76 of the Presidential Decree 445 of 28 December 2000, in the event of false declarations or the formation, exhibition or use of false documents, or documents containing data that no longer correspond to the truth, declares and attests under his/her own responsibility:
That are no causes of prohibition, forfeiture or suspension pursuant to art. 67 of Legislative Decree 06/09/2011 No. 159, for the undersigned and/or cohabiting family members aged 18 or more (whose data are made available below).
FIRST NAME LAST NAME Date of Birth Place of Birth Fiscal Code
The undersigned also declares to be fully informed, pursuant to Legislative Decree No. 196/2003 (Code regarding the protection of personal data), that the data collected will be processed, even with IT tools, exclusively within the purpose of the procedure for which this declaration is made.
Date
Signature
Provide copy of the Identity document of the subscriber.
This declaration does not require the authentication of the signature and replaces, for all the intents and purposes, the normal certifications required by a Public Administration, as well as for managers of public services and the private sector who allow it.
Legislative Decree 06/09/2011 n. 159, art. 85 https://def.finanze.it/DocTribFrontend/decodeurn?urn=urn:doctrib::DLG:2011-09-06;159_art85
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