3-Form - Scrutinized.pdf
PDF 77 KB Posted
- Attached to
- MPO General Planning Consultant State and local contract opportunity
- Solicitation number
- 2027005
- Issued by
- Indian River County, Florida
About this file
This is a Form 3 Scrutinized Companies Certification document related to the Indian River County Metropolitan Planning Organization (MPO) General Planning Consultant contract opportunity in Florida. The form serves as a certification and disclosure document requiring vendors to attest to their compliance status regarding scrutinized companies lists maintained by the State of Florida. The document establishes the vendor's responsibility to verify that neither the company nor its operations, suppliers, or business partners appear on any state-designated scrutinized companies lists, including those related to companies involved with Iran, the Boycott, Divestment, and Sanctions (BDS) movement, or other restricted entities as defined by Florida law.
The certification form requires the submitting company to confirm compliance with applicable Florida statutes regarding scrutinized companies before contract award. Failure to properly complete and submit this form may result in contract ineligibility or disqualification of the bid. The form is a standard compliance document that must accompany the vendor's proposal for the MPO General Planning Consultant services, which involve assisting the Indian River County MPO staff in developing studies, policy documents, and plans.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| 6-Form - RFP-RFQ Compliance Form.pdf | ||
| 5-Form - Debarment.pdf | ||
| 8-RFQ 2027005 for MPO General Consulting Services.pdf | ||
| 7-Form - Foreign Entity Ownership.pdf | ||
| 1-Form - Lobbying.pdf | ||
| 4-Form - Anti-Human Traffic.pdf | ||
| 9-Professional Services Agreement.docx | DOCX document | |
| 2-Form - Disclosure Form.pdf | ||
| 10-Exhibit 2 - G3R67 FDOT MPO Agreement.pdf |
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Text version
CERTIFICATION REGARDING PROHIBITION AGAINST
CONTRACTING WITH SCRUTINIZED COMPANIES
(This form MUST be submitted with your bid/proposal/SOQ)
I hereby certify that neither the undersigned entity, nor any of its wholly owned subsidiaries, majority-owned subsidiaries, parent companies, or affiliates of such entities or business associations, that exists for the purpose of making profit have been placed on the Scrutinized Companies that Boycott Israel List created pursuant to s. 215.4725 of the Florida Statutes, or are engaged in a boycott of Israel.
In addition, if this solicitation is for a contract for goods or services of one million dollars or more, I hereby certify that neither the undersigned entity, nor any of its wholly owned subsidiaries, majority-owned subsidiaries, parent companies, or affiliates of such entities or business associations, that exists for the purpose of making profit are on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, created pursuant to s. 215.473 of the Florida Statutes, or are engaged in business operations in Cuba or Syria as defined in said statute.
I understand and agree that the County may immediately terminate any contract resulting from this solicitation upon written notice if the undersigned entity (or any of those related entities of respondent as defined above by Florida law) are found to have submitted a false certification or any of the following occur with respect to the company or a related entity: (i) it has been placed on the Scrutinized Companies that Boycott Israel List, or is engaged in a boycott of Israel, or (ii) for any contract for goods or services of one million dollars or more, it 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 it is found to have been engaged in business operations in Cuba or Syria.
Name of Respondent: ___________________________________
By: ________________________________________________ (Authorized Signature)
Name:
Title: ______________________________________________
Date:_____________________________
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File details come from the government source that posted it. Updated .