3-Attachment D-Scrutinized Co Cert.pdf
PDF 185 KB Posted
- Attached to
- COMPACT UTILITY TRACTOR
- Solicitation number
- PROJ-26-072
- Issued by
- Florida
About this file
This is a Vendor Certification form regarding Scrutinized Companies required by Halifax Health, a Florida government entity, for participation in contract opportunities. The certification applies to all vendors bidding on, submitting proposals for, or entering into contracts with Halifax Health for the procurement of a replacement compact utility tractor for Facility Operations, including factory-installed loader, single point hydraulic coupler and bucket, specified tires, applicable warranties, and delivery to the main campus. Vendors must complete and sign the certification form, providing their business name, Federal Employer Identification Number (FEIN), authorized representative information, and contact details prior to contract award.
The certification requires vendors to attest that their company is not listed on the Scrutinized Companies that Boycott Israel List, the Scrutinized Companies with Activities in Sudan List, or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, and that the company is not engaged in boycotts of Israel or business operations in Cuba or Syria. For contracts valued at one million dollars or more, the restrictions on Sudan, Iran Petroleum Energy Sector activities, and Cuba and Syria operations apply; for contracts of any amount, the Israel boycott restrictions apply. Vendors understand that submission of false certification may result in civil penalties, attorney's fees, and costs, and that Halifax Health may terminate any contract if the vendor submits false information or is subsequently placed on any of the prohibited lists. This certification is required under Section 287.135, Florida Statutes, and Section 215.4725 and 215.473, Florida Statutes.
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Text version
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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