3-AttachmentCAnti-DiscriminationAgainstIsraelAffidavit.pdf
PDF 98 KB Posted
- Attached to
- Benefits Consultant
- Solicitation number
- 26-08101
- Issued by
- Missouri
About this file
This is an Affidavit of Compliance with Missouri Anti-Discrimination Against Israel Act required for the Rockwood School District's Benefits Consultant contract opportunity in Missouri. The affidavit applies to contracts exceeding $100,000 and companies with ten or more employees. The document requires an authorized representative of the bidding business entity to swear under oath that the company is not currently engaged in and will not engage in a boycott of goods or services from the State of Israel, companies authorized by or licensed by the State of Israel, or companies, persons, or entities doing business in or with Israel during the term of the agreement. The affiant must certify that the affidavit is being signed as a free act without duress.
The affidavit must be notarized and executed in compliance with Missouri Statute RSMo 34.600. The document requires completion of standard notary elements including the state and county where the affidavit is sworn, the date of execution, the affiant's title and authorization to act on behalf of the business entity, the affiant's signature, and the notary public's signature with commission expiration date. This compliance affidavit is a mandatory submission requirement for bidders on the Rockwood School District's benefits consulting services solicitation.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 5-26-08101 Addendum 1.pdf | ||
| 4-26 08101 RFP Instructions.pdf | ||
| 1-E-Verify.pdf | ||
| 2-Acknowledgement Form.pdf | ||
| 6-26-08101 Addendum 1 2026-27 Premium Rates - Annual Contributions RFP Response.xlsx | XLSX spreadsheet |
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Text version
AFFIDAVIT OF COMPLIANCE
WITH MISSOURI ANTI-DISCRIMINATION AGAINST ISRAEL ACT
(Contracts in excess of $100,0000.00/Companies with 10 employees or more)
STATE OF _____________________ )
) ss.
COUNTY OF ____________________ )
On this ________ day of _______________________, 20___, before me appeared ____________________________________________, personally known by me or otherwise proven to be the person whose name is subscribed on this affidavit and who, being duly sworn, stated as follows:
I am of sound mind, capable of making this affidavit, and personally swear or affirm that the statements made herein are truthful to the best of my knowledge. I am the ______________________________ (title) of _________________________________ (business entity) and I am duly authorized, directed or empowered to act with full authority on behalf of the business entity in making this affidavit.
Pursuant to RSMo § 34.600, I hereby swear or affirm that the business entity is not currently engaged in and shall not, for the duration of this agreement, engage in a boycott of goods or services from the State of Israel; companies authorized by, licensed by, or organized under the laws of the State of Israel; or companies, persons, or entities doing business in or with the state of Israel.
I acknowledge that I am signing this affidavit as the free act and deed of the business entity and that I am not doing so under duress.
Affiant’s Signature
Subscribed and sworn to before me this ______ day of ___________________, 20____.
Notary Public
My Commission expires:
File details come from the government source that posted it. Updated .