4-Attachment B-Bidders Cert.pdf
PDF 1 MB Posted
- Attached to
- Vein Finder for HMC Oncology
- Solicitation number
- PROJ-26-045
- Issued by
- Volusia County, Florida
About this file
This is a Bidders Certification form for Halifax Health Medical Center in Florida, required as part of the bidding process for a Vein Finder procurement for HMC Oncology. The certification document establishes the formal attestation requirements that bidders must complete and submit with their proposals. Bidders must certify that they have received complete bid documents, have not engaged in collusion or unethical practices, comply with all federal, state, and local employment laws and regulations, maintain a written sexual harassment policy meeting applicable legal requirements, and will abide by all applicable codes, rules, regulations, ordinances, and statutes. The form requires completion of company information, identification of the authorized corporate official, signature, date, and contact information on the first page.
The second page contains a sworn tax certification statement in which the bidder's executing officer must attest under oath that all statements are true and correct and made on behalf of the bidder with proper authorization. The bidder must certify that it is not barred from contracting with any unit of local government in Florida due to tax payment delinquencies with the Florida Department of Revenue, unless the bidder is actively contesting the liability or amount of the tax through established statutory procedures. The certification requires notarization and must be executed with the bidder's official signature, printed name, and title, along with witness attestation and the notary public seal.
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Text version
ATTACHMENT B
HALIFAX HEALTH MEDICAL CENTER
BIDDERS CERTIFICATION
I/We hereby certify that:
A. A complete set of bid papers, as intended, has been received, and I/We will abide by the contents and/or information received and/or contained herein.
B. I/We have not entered into any collusion or other unethical practices with any person, firm, or employee of the District which would in any way be construed as unethical practice.
C. I/We comply with all current federal, state and local laws, statutes, rules, and regulations referencing equal opportunity employment practices.
D. I/We have adopted a written sexual harassment policy which is in accordance with the requirements of federal, state and local laws, regulations and policies.
E. I/We will abide by all other federal, state and local codes, rules, regulations, ordinances and statutes.
COMPANY NAME
ADDRESS
DISTRICT/STATE/ZIP CODE
NAME OF CORPORATE/COMPANY OFFICIAL
(PLEASE TYPE OR PRINT CLEARLY)
TITLE
AUTHORIZED OFFICIAL SIGNATURE
DATE
TELEPHONE ( )
HALIFAX HEALTH MEDICAL CENTER
STATE OF FLORIDA
COUNTY OF
BIDDER’S TAX CERTIFICATION
(BIDDER’S EXECUTING OFFICER), being first duly sworn on oath, deposes and states that all statements made herein are made on behalf of the Bidder, that this respondent is authorized to make them and that the statements contained herein are true and correct. Bidder deposes, states and certifies that Bidder is not barred from contracting with any unit of local government in the State of Florida as result of a delinquency in payment of any tax administered by the Florida Department of Revenue unless Bidder is contesting, in accordance with the procedures established by the appropriate statute, its liability for the tax or the amount of the tax.
DATED this day of , 2024.
By (Bidder’s Executing Officer)
(Name of Bidder’s Executing Officer)
(Title)
ATTEST/WITNESS:
By
Title
Subscribed and sworn to before me this day of , 2024.
Notary Public
(SEAL)
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