2-Senergy BPM004763 SPO Form 205 - Boycott of Israel.pdf
PDF 407 KB Posted
- Attached to
- Master Agreement AZ|CTR063147
- Contract number
- CTR063147
- Issued by
- Arizona
About this file
The document is a Boycott of Israel Disclosure form from the Arizona Department of Transportation (ADOT) Procurement division, associated with Solicitation No. BPM04763. The form requires contractors to certify whether they are participating in a boycott of Israel, as mandated by Arizona Revised Statutes (A.R.S.) §35-393.01. The specific company completing this form is Senergy Petroleum, located in Phoenix, Arizona, with the document signed by Carlos Zubiate in the role of Contract Specialist.
While the document does not detail the specific goods or services under contract, it is a mandatory compliance form for public entity contracts in Arizona. The form requires companies with ten or more full-time employees to certify that they are not engaging in a boycott of goods or services from Israel, with exemptions for contracts under $100,000, sole proprietorships, companies with fewer than ten employees, or non-profit organizations. In this case, Senergy Petroleum has checked the box indicating they do not participate in and will not participate in a boycott of Israel during the contract term, thereby meeting the state's procurement requirements.
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Text version
Procurement
PARTICIPATION IN BOYCOTT OF ISRAEL
Solicitation No: BPM04763 Available online at https://app.az.gov
SPO Form 205 (rev 10-2019)
Boycott of Israel Disclosure Please note that if any of the following apply to this Solicitation, Contract, or Contractor, then the Offeror shall select the “Exempt Solicitation, Contract, or Contractor” option below:
• The Solicitation or Contract has an estimated value of less than $100,000;
• Contractor is a sole proprietorship;
• Contractor has fewer than ten (10) employees; OR
• Contractor is a non-profit organization.
Pursuant to A.R.S. §35-393.01, public entities are prohibited from entering into contracts “unless the contract includes a written certification that the company is not currently engaged in, and agrees for the duration of the contract to not engage in, a boycott of goods or services from Israel.”
Under A.R.S. §35-393:
1. "Boycott" means engaging in a refusal to deal, terminating business activities or performing other actions that are intended to limit commercial relations with entities doing business in Israel or in territories controlled by Israel, if those actions are taken either:
(a) Based in part on the fact that the entity does business in Israel or in territories controlled by Israel.
(b) In a manner that discriminates on the basis of nationality, national origin or religion and that is not based on a valid business reason.
2. "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.
5. "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.
The certification below does not include boycotts prohibited by 50 United States Code Section 4842 or a regulation issued pursuant to that section. See A.R.S. §35-393.03.
In compliance with A.R.S. §§35-393 et seq., all offerors must select one of the following:
The Company submitting this Offer does not participate in, and agrees not to participate in during the term of the contract, a boycott of Israel in accordance with A.R.S. §§35-393 et seq. I understand that my entire response will become public record in accordance with A.A.C. R2-7-C317.
☐ The Company submitting this Offer does participate in a boycott of Israel as described in A.R.S. §§35-393 et seq.
Exempt Solicitation, Contract, or Contractor.
Indicate which of the following statements applies to this Contract:
☐ Solicitation or Contract has an estimated value of less than $100,000;
☐ 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
City State Zip Title
Senergy Petroleum
622 S. 56th Ave.
Phoenix AZ 85403
Carlos Zubiate
Contract Specialist https://app.az.gov/
Boycott of Israel Disclosure
File details come from the government source that posted it. Updated .