25520001_-_Iran_Contracting_Act_Certification.pdf

This document is an Iran Contracting Act Verification Form issued by the California Department of General Services (DGS) Procurement Division, pertaining to Public Contract Code sections 2202-2208. The form requires vendors or financial institutions bidding on state contracts valued at $1,000,000 or more to certify their status regarding investment activities in Iran. Vendors must either confirm they are not on the current list of persons engaged in Iranian investment activities or demonstrate they have been exempted from the certification requirement.

The form provides two options for compliance: Option #1 allows vendors to certify they are not on the DGS list of persons engaged in Iranian investment activities, and Option #2 permits vendors to seek an exemption on a case-by-case basis. California law establishes significant penalties for providing false certifications, including civil penalties up to $250,000, contract termination, and a three-year bid ineligibility. Vendors must complete the form by inserting their name, Federal ID Number, and selecting one of the two options before submitting a proposal or executing a state contract.