ATTACHMENT G - Contractor Certification Form.docx
DOCX document 15 KB Posted
- Solicitation number
- 36C24226R0081
About this file
This is a Contractor Certification Form that serves as an attachment to the solicitation for VISN 2 Prosthetics Downstate Home Oxygen Services (Solicitation Number 36C24226R0081). The form is a template designed for contractors to complete and submit as part of their proposal response to the Department of Veterans Affairs Veterans Health Administration, Veterans Integrated Service Network 2. As a certification form attachment, it functions as a required appendix to the main solicitation documents rather than detailing specific product or service requirements, pricing terms, or award information. Contractors responding to this opportunity must complete and include this form with their submissions to attest to compliance with federal contracting requirements and any specific certifications mandated by the contracting officer for the downstate home oxygen services contract.
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ATTACHMENT G – CONTRACTOR CERTIFICATION: Immigration and Nationality Act of 1952, As Amended
IMPORTANT: A completed copy of this certification must be included with your proposal response.
The Contractor certifies that the Contractor shall comply with any and all legal provisions contained in the Immigration and Nationality Act of 1952, As Amended; its related laws and regulations that are enforced by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor as these may relate to non-immigrant foreign nationals working under contract or subcontract for the Contractor while providing services to Department of Veterans Affairs patient referrals;
While performing services for the Department of Veterans Affairs, the Contractor shall not knowingly employ, contract or subcontract with an illegal alien; foreign national non-immigrant who is in violation their status, as a result of their failure to maintain or comply with the terms and conditions of their admission into the United States. Additionally, the Contractor is required to comply with all “E-Verify” requirements consistent with “Executive Order 12989” and any related pertinent Amendments, as well as applicable Federal Acquisition Regulations.
If the Contractor fails to comply with any requirements outlined in the preceding paragraphs or its Agency regulations, the Department of Veterans Affairs may, at its discretion, require that the foreign national who failed to maintain their legal status in the United States or otherwise failed to comply with the requirements of the laws administered by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor, shall be prohibited from working at the Contractor’s place of business that services Department of Veterans Affairs patient referrals; or other place where the Contractor provides services to veterans who have been referred by the Department of Veterans Affairs; and shall form the basis for termination of this contract for breach.
The Contractor agrees to obtain a similar certification from its subcontractors.
Signature: ____________________________________________ Date: ___________________________________________________ Typed Name and Title: _______________________________________ Company Name: ______________________________________ This certification concerns a matter within the jurisdiction of an agency of the United States and the making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under 18 U.S.C. 1001.
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