2-InGenesis, Inc. - BPM006391_Attachment_E_Forced_Labor.pdf
PDF 364 KB Posted
- Attached to
- Registry Staffing for the Arizona State Hospital
- Solicitation number
- BPM006391
- Issued by
- Maricopa County, Phoenix City, Arizona
About this file
This is a Forced Labor of Ethnic Uyghurs Ban certification form (SPO Form 205) issued by the Arizona Department of Health Services in connection with Solicitation No. BPM006391 for Registry Staffing Services at the Arizona State Hospital. The form requires written certification from contractors to demonstrate compliance with Arizona Revised Statutes (A.R.S.) 35-394, which prohibits the use of forced labor of ethnic Uyghurs in the People's Republic of China or goods and services produced through such labor. InGenesis, Inc., a San Antonio, Texas-based staffing company with a contact person identified as Veronica Edwards, CEO, submitted this certification as part of their bid response for the contract opportunity.
The certification form applies to companies with ten or more full-time employees bidding on contracts with Arizona public entities; sole proprietorships, organizations with fewer than ten employees, and non-profit organizations are exempt from this requirement. InGenesis, Inc. did not claim exemption status and instead certified that the company does not use, and agrees not to use during the contract term, forced labor of ethnic Uyghurs, goods or services produced by such labor, or contractors, subcontractors, or suppliers that engage in such practices. The form was completed and signed by authorized company representatives with contact information provided as edwardsv@ingenesis.com and (210) 366-0033. This certification represents a mandatory compliance document required for contract award consideration rather than a substantive project deliverable.
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Text version
Attachment E
Forced Labor of Ethnic Uyghurs Ban
ARIZONA DEPARTMENT OF
HEALTH SERVICES
150 North 18th Avenue, Suite 530
Phoenix, AZ 85007 Solicitation No.: BPM006391
PAGE
Description: REGISTRY STAFFING FOR THE
ARIZONA STATE HOSPITAL
OF
SPO Form 205 – Forced Labor of Ethnic Uyghurs Ban | Revision No. 1 | Revised 09-22
Forced Labor of Ethnic Uyghurs Ban
Please note that if any of the following apply to the Contractor, then the Offeror shall select the “Exempt
Contractor” option below:
● Contractor is a sole proprietorship;
● Contractor has fewer than ten (10) employees; OR
● Contractor is a non-profit organization.
Pursuant to A.R.S. § 35-394, written certification is required to show that the company entering into a contract with a public entity does not use the forced labor, or any goods or services produced by the forced labor, of ethnic Uyghurs in the People's Republic of China.
Under A.R.S. § 35-394:
1. "Company" means an organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, limited liability company or other entity or business association, including a wholly owned subsidiary, majority-owned subsidiary, parent company or affiliate, that engages in for-profit activity and that has ten or more full-time employees.
2. "Public entity" means this State, a political subdivision of this State or an agency, board, commission or department of this State or a political subdivision of this State.
In compliance with A.R.S. §§ 35-394 et seq., all offerors must select one of the following:
☐ The Company submitting this Offer does not use, and agrees not to use during the term of the contract, any of the following:
● Forced labor of ethnic Uyghurs in the People’s Republic of China;
● Any goods or services produced by the forced labor of ethnic Uyghurs in the People’s Republic of
China; or
● Any Contractors, Subcontractors, or suppliers that use the forced labor or any goods or services produced by the forced labor of ethnic Uyghurs in the People’s Republic of China.
☐ The Company submitting this Offer does participate in use of Forced Uyghurs Labor as described in A.R.S. §
35-394.
☐ Exempt Contractor
Indicate which of the following statements applies to the Contractor (may be more than one):
☐ Contractor is a sole proprietorship;
☐ Contractor has fewer than ten (10) employees; and/or
☐ Contractor is a non-profit organization.
Company Name Signature of person authorized to sign
Address Printed name and title
City, State, ZIP Contact email address Contact phone number x
InGenesis, Inc.
18756 Stone Oak Parkway, Suite 200 Veronica Edwards, CEO
San Antonio, TX 78258 edwardsv@ingenesis.com (210) 366-0033
File details come from the government source that posted it. Updated .