3-RFB 3922 Iran Contracting Act Certification.pdf

IRAN CONTRACTING ACT CERTIFICATION

RFB #3922

MUST BE SUBMITTED WITH BID PROPOSAL IF BID AMOUNT IS $1,000,000 OR MORE

Prior to bidding on, submitting proposal, or executing a contract or renewal for a public entity contract for goods or services of $1,000,000 or more, a Company must either: a) certify it is not on the current list of persons engaged in investment activities in Iran created by the California Department of General Services (“DGS”) pursuant to Public Contract Code section 2203(b) and is not a financial institution extending $20,000,000 or more in credit to another person, for 45 days or more, if that other person will use the credit to provide goods or services in the energy sector in Iran and is identified on the current list of persons engages in investment activities in Iran created by DGS; or b) demonstrate it has been exempted from the certification requirement for that solicitation or contract pursuant to Public Contract Code section 2203(c) or (d).

To comply with this requirement, please insert your Company or financial institution name and Federal ID Number (if available) and complete one of the options below. Please note: California law establishes penalties for providing false certifications, including civil penalties equal to the greater of $250,000 or twice the amount of the contract for which the false certification was made, contract termination, and three-year ineligibility to bid on contracts. (Pub. Cont. Code 2205.)

OPTION #1 – CERTIFICATION

I, the official named below, certify I am duly authorized to execute this certification on behalf of the Company/financial institution identified below, and the Company/financial institution identified below is not on the current list of persons engaged in investment activities in Iran created by DGS and is not a financial institution extending twenty million dollars ($20,000,000) or more in credit to another person/Company, for 45 days or more, if that other person/Company will use the credit to provide goods or services in the energy sector in Iran and is identified on the current list of persons engaged in investment activities in Iran created by DGS.

Pursuant to the Iran Contract Act of 2010 (Public Contract Code 2200-2208), Proposers/Bidders are ineligible to bid on or submit a proposal for any contract with a public entity for goods or services of one million dollars ($1,000,0000) or more if the Company/Bidder engages in investment activities in Iran.

For bids $1,000,000 or more, bidders must certify that it is not on the list of ineligible Proposers prohibited from doing business with the State of California and shall complete the Iran Contract Act Certification attached and submit with their proposal at the time of bid. Failure to do so ay deem your bid non-responsive.

Ryan Emblem Highlight

RFB #3922

I certify (or declare) under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Company Name/Financial Institution (Printed) Federal ID Number (or n/a)

By (Authorized Signature)

Printed Name and Title of Person Signing Date Executed

OPTION #2 – EXEMPTION

Pursuant to Public Contract Code Sections 2203(c) and (d), a public entity may permit a Company/financial institution engaged in investment activities in Iran, on a case-by-case basis, to be eligible for, or to bid on, submit a proposal for, or enters into or renews, a contract for goods and services.

If you have obtained an exemption from the certification requirement under the Iran Contracting Act, please fill out the information below, and attach documentation demonstrating the exemption approval.

Company Name/Financial Institution (Printed) Federal ID Number (or n/a)

By (Authorized Signature)

Printed Name and Title of Person Signing Date Executed