3-Attachment D-Scrutinized Co Cert.pdf
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- Attached to
- NETAPP Storage Hardware
- Solicitation number
- PROJ-26-024
- Issued by
- Volusia County, Florida
About this file
This is a vendor certification form required by Halifax Health, a Florida-based government entity, for participation in contract opportunities. The certification document requires vendors to complete identification information including company name, FEIN, authorized representative details, and contact information. The form applies to the NetApp Storage Hardware procurement, which involves high-performance, scalable storage solutions with integrated data protection, hybrid cloud connectivity, and comprehensive support services based on NetApp ONTAP architecture.
The certification mandates that vendors attest to compliance with Florida Statutes sections 287.135 and 215.473, prohibiting participation by companies listed on the Scrutinized Companies that Boycott Israel List, those engaged in boycotts of Israel, and those with activities in Sudan, Iran's petroleum energy sector, Cuba, or Syria. For contracts valued at one million dollars or less, restrictions apply only to Israel-related boycott lists. For contracts exceeding one million dollars, all prohibited activities apply. Vendors must certify non-involvement in these activities under penalty of civil penalties, attorney's fees, and costs. Halifax Health reserves the right to terminate any contract if a vendor submits false certification or becomes listed on any prohibited entity list. An authorized company representative must sign and date the certification form prior to bid submission.
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Attachment D
VENDORS CERTIFICATION REGARDING SCRUTINIZED COMPANIES
Vendor Name: ________________________________________________________________
Vendor FEIN: __________________________________
Vendors Authorized Representative Name and Title: ___________________________________
Address: _____________________________________________________________________
City: ___________________________________ State: ___________ Zip: ______________
Telephone Number: ____________________________
Email Address: ________________________________________________________________
Section 287.135(2)(a), Florida Statutes, prohibits a company from bidding on, submitting a proposal for, or entering into or renewing a contract for goods or services of any amount if, at the time of contracting or renewal, the company is on the Scrutinized Companies that Boycott Israel List, created pursuant to § 215.4725, Florida Statutes, or is engaged in a boycott of Israel.
Section 287.135(2)(b), Florida Statutes, further prohibits a company from bidding on, submitting a proposal for, or entering into or renewing a contract for goods or services over one million dollars ($1,000,000) if, at the time of contracting or renewal, the company is on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, both created pursuant to § 215.473, Florida Statutes, or the company is engaged in business operations in Cuba or Syria.
As the person authorized to sign on behalf of the Vendor, I hereby certify that the company identified in the Section entitled “Vendor Name” above is not listed on any of the following: (i) the Scrutinized Companies that Boycott Israel List, (ii) Scrutinized Companies with Activities in Sudan List, or (iii) the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List. I further hereby certify that the company identified above is not engaged in a boycott of Israel or engaged in business operations in Cuba or Syria. I understand that pursuant to § 287.135, Florida Statutes, the submission of a false certification may subject the company to civil penalties, attorney’s fees, and/or costs. I further understand that any contract with Halifax Health for goods or services of any amount may be terminated at the option of Halifax Health if the company (i) is found to have submitted a false certification, (ii) has been placed on the Scrutinized Companies that Boycott Israel List, or (iii) is engaged in a boycott of Israel. And, in addition to the foregoing, if the amount of the contract is one million dollars ($1,000,000) or more, the contract may be terminated at the option of Halifax Health if the company is found to have submitted a false certification, has been placed on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or has been engaged in business operations in Cuba or Syria.
Signature of Authorized Representative: ___________________________________________
Printed Name: _____________________________________________ Date:_____________
Title of Authorized Representative: ________________________________________________
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