4-Anti-Discrimination Against Israel Affidavit (2).pdf
PDF 99 KB Posted
- Attached to
- OEM Toner Cartridges
- Solicitation number
- 26-13201
- Issued by
- Missouri
About this file
This is an Affidavit of Compliance form required by the State of Missouri for contracts exceeding $100,000 with companies employing 10 or more individuals. The affidavit pertains to the OEM Toner Cartridges Request for Bids issued by a Missouri district seeking qualified vendors to supply Original Equipment Manufacturer toner cartridges. The document serves as a compliance certification that must be completed and notarized by an authorized representative of the bidding business entity prior to contract award.
The affidavit requires the signatory to swear or affirm compliance with Missouri Statute RSMo 34.600, specifically certifying that the business entity 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 for the duration of the agreement. The affiant must acknowledge that the signature is executed freely and voluntarily without duress. This certification is a mandatory requirement for contract eligibility under Missouri's Anti-Discrimination Against Israel Act.
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Other files
| File | Type | Posted |
|---|---|---|
| 3-E-Verify (3).pdf | ||
| 2-26-13201.pdf | ||
| 1-Acknowledgement Form.pdf |
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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 .