22._Iran_Contracting_Act_(CCHCS-MC-323).pdf
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- Solicitation number
- 0000035871
- Issued by
- California
About this file
This document is an Iran Contracting Act certification form issued by California Correctional Health Care Services (CCHCS) for Bid Number SD24-00021, pertaining to state of California contract requirements. The form is designed to ensure vendors/financial institutions bidding on contracts of $1 million or more certify they are not engaged in investment activities in Iran. Vendors must complete either Option #1 (Certification) stating they are not on the current list of persons engaged in investment activities in Iran, or Option #2 (Exceptions) if they have obtained a specific exemption.
The document outlines significant legal and financial consequences for non-compliance, including potential civil penalties of $250,000 or twice the contract amount, contract termination, and a three-year ineligibility to bid on state contracts. Vendors must provide their company name, Federal Employer Identification Number (FEIN), an authorized signature, and other identifying information to demonstrate compliance with the Iran Contracting Act of 2010. The form allows for case-by-case exceptions, requiring vendors to attach documentation demonstrating exemption approval if applicable.
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Bid Number: SD24-00021
CCHCS-MC-323 – Iran Contracting Act Rev. 09/26/2018
IRAN CONTRACTING ACT
Per the Iran Contracting Act of 2010 (Public Contract Code sections 2202-2208), prior to bidding on, submitting a proposal or executing a contract or renewal for a state of California contract for goods or services of $1 million or more, a vendor must either: (1) certify it is not on the current list of persons engaged in investment activities in Iran created by the Department of General Services (DGS) and/or a vendor/financial institution extending $20 million or more in credit to another person, for 45 days or more, if that other person will use the credit to provide goods or services in the energy sector in Iran and is identified on the current list as a person engaging in investment activities in Iran created by DGS; or (2) demonstrate it has been exempted from the certification requirement for that solicitation or contract.
To comply with this requirement, please insert your vendor/financial institution name and Federal Employer Identification Number (FEIN) and complete one of the options below. Please note: California law establishes penalties for providing false certifications, including civil penalties equal to the greater of $250,000 or twice the amount of the contract for which the false certification was made, contract termination, and three year ineligibility to bid on contracts pursuant to Public Contract Code section 2205(a).
OPTION #1 – CERTIFICATION
I, the official named below, certify I am duly authorized to execute this certification on behalf of the vendor/financial institution identified below, and the vendor/financial institution identified below is not on the current list of persons engaged in investment activities in Iran created by DGS and is not a financial institution extending $20 million or more in credit to another person/vendor, for 45 days or more, if that other person/vendor will use the credit to provide goods or services in the energy sector in Iran and is identified on the current list of persons engaged in investment activities in Iran created by DGS.
Vendor Name/Financial Institution (Printed) Federal Employer Identification Number (FEIN)
By (Authorized Signature)
Printed Name and Title of Person Signing
Date Executed Executed in the County and State of
OPTION #2 – EXCEPTIONS
Pursuant to Public Contract Code section 2203(c)-(d), a public entity may permit a vendor/financial institution engaged in investment activities in Iran, on a case-by-case basis, to be eligible for, or to bid on, submit a proposal for, or enter into or renew, a contract for goods or services of $1 million or more with a public entity.
If you have obtained an exemption from the certification requirement under the Iran Contracting Act, please fill out the information below, and attach documentation demonstrating the exemption approval.
Vendor Name/Financial Institution (Printed) Federal Employer Identification Number (FEIN)
By (Authorized Signature)
Printed Name and Title of Person Signing
Date Executed Executed in the County and State of
| Vendor NameFinancial Institution Printed: |
| Federal Employer Identification Number FEIN: |
| Printed Name and Title of Person Signing: |
| Date Executed: |
| Executed in the County and State of: |
| Vendor NameFinancial Institution Printed_2: |
| Federal Employer Identification Number FEIN_2: |
| Printed Name and Title of Person Signing_2: |
| Date Executed_2: |
| Executed in the County and State of_2: |
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