3-Attachment B-Bidders Cert (1).pdf
PDF 1 MB Posted
- Attached to
- Ophthalmology Practice Equipment
- Solicitation number
- PROJ-25-160
- Issued by
- Volusia County, Florida
About this file
This is a Bidders Certification form for Halifax Health Medical Center in Florida, establishing the legal and compliance requirements that bidders must meet when submitting bids for the Ophthalmology Practice Equipment procurement (PROJ-25-160). The certification form requires bidders to confirm receipt of complete bid documents, affirm compliance with federal, state, and local laws regarding equal opportunity employment practices, certify adoption of written sexual harassment policies, and declare that they have not engaged in collusion or unethical practices with any person or District employee. Bidders must also commit to abiding by all applicable federal, state, and local codes, regulations, ordinances, and statutes. The form requires completion by an authorized corporate or company official, including typed or printed name, title, signature, date, telephone number, and email address.
The second section of the certification is a sworn statement by the Bidder's Executing Officer, affirmed before a notary public, certifying that all statements made are true and correct and that the bidder is authorized to execute the certification on behalf of the bidding company. The executing officer must further certify that the bidder is not barred from contracting with any unit of local government in Florida due to tax delinquency with the Florida Department of Revenue, unless the bidder is actively contesting such liability or amount through established statutory procedures. This certification document serves as a prerequisite for bid submission and establishes the ethical and legal framework governing the bidding process for this ophthalmology equipment procurement opportunity with bids due by 2:00 PM EST on December 17, 2025.
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Text version
ATTACHMENT B
HALIFAX HEALTH MEDICAL CENTER
BIDDERS CERTIFICATION
I/We hereby certify that:
A. A complete set of bid papers, as intended, has been received, and I/We will abide by the contents and/or information received and/or contained herein.
B. I/We have not entered into any collusion or other unethical practices with any person, firm, or employee of the District which would in any way be construed as unethical practice.
C. I/We comply with all current federal, state and local laws, statutes, rules, and regulations referencing equal opportunity employment practices.
D. I/We have adopted a written sexual harassment policy which is in accordance with the requirements of federal, state and local laws, regulations and policies.
E. I/We will abide by all other federal, state and local codes, rules, regulations, ordinances and statutes.
COMPANY NAME
ADDRESS
DISTRICT/STATE/ZIP CODE
NAME OF CORPORATE/COMPANY OFFICIAL
(PLEASE TYPE OR PRINT CLEARLY)
TITLE
AUTHORIZED OFFICIAL SIGNATURE
DATE
TELEPHONE ( )
HALIFAX HEALTH MEDICAL CENTER
STATE OF FLORIDA
COUNTY OF
BIDDER’S TAX CERTIFICATION
(BIDDER’S EXECUTING OFFICER), being first duly sworn on oath, deposes and states that all statements made herein are made on behalf of the Bidder, that this respondent is authorized to make them and that the statements contained herein are true and correct. Bidder deposes, states and certifies that Bidder is not barred from contracting with any unit of local government in the State of Florida as result of a delinquency in payment of any tax administered by the Florida Department of Revenue unless Bidder is contesting, in accordance with the procedures established by the appropriate statute, its liability for the tax or the amount of the tax.
DATED this day of , 2024.
By (Bidder’s Executing Officer)
(Name of Bidder’s Executing Officer)
(Title)
ATTEST/WITNESS:
By
Title
Subscribed and sworn to before me this day of , 2024.
Notary Public
(SEAL)
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