4-Attachment D-Scrutinized Co Cert.pdf
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- Attached to
- HOSPITAL GRADE – UV - C
- Solicitation number
- PROJ-25-130
- Issued by
- Volusia County, Florida
About this file
This document is a vendor certification form from Halifax Health regarding scrutinized companies under Florida law. The form requires vendors to complete their identifying information including name, FEIN, authorized representative details, and contact information, though no specific products, services, quantities, dates, or contract terms are mentioned in this certification document.
The certification addresses compliance with Florida Statutes Section 287.135, which prohibits companies from bidding on or entering into contracts if they are listed on scrutinized company lists related to boycotts of Israel, activities in Sudan, or activities in Iran's petroleum energy sector. For contracts over one million dollars, additional restrictions apply to companies with business operations in Cuba or Syria. The form requires the vendor's authorized representative to certify that their company is not engaged in any prohibited activities and warns that false certifications may result in civil penalties, attorney's fees, and contract termination. No specific pricing terms, set-asides, or funding information are included as this is strictly a compliance certification document.
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Text version
Attachment D
VENDORS CERTIFICATION REGARDING SCRUTINIZED COMPANIES
Vendor Name: ________________________________________________________________
Vendor FEIN: __________________________________
Vendors Authorized Representative Name and Title: ___________________________________
Address: _____________________________________________________________________
City: ___________________________________ State: ___________ Zip: ______________
Telephone Number: ____________________________
Email Address: ________________________________________________________________
Section 287.135(2)(a), Florida Statutes, prohibits a company from bidding on, submitting a proposal for, or entering into or renewing a contract for goods or services of any amount if, at the time of contracting or renewal, the company is on the Scrutinized Companies that Boycott Israel List, created pursuant to § 215.4725, Florida Statutes, or is engaged in a boycott of Israel.
Section 287.135(2)(b), Florida Statutes, further prohibits a company from bidding on, submitting a proposal for, or entering into or renewing a contract for goods or services over one million dollars ($1,000,000) if, at the time of contracting or renewal, the company is on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, both created pursuant to § 215.473, Florida Statutes, or the company is engaged in business operations in Cuba or Syria.
As the person authorized to sign on behalf of the Vendor, I hereby certify that the company identified in the Section entitled “Vendor Name” above is not listed on any of the following: (i) the Scrutinized Companies that Boycott Israel List, (ii) Scrutinized Companies with Activities in Sudan List, or (iii) the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List. I further hereby certify that the company identified above is not engaged in a boycott of Israel or engaged in business operations in Cuba or Syria. I understand that pursuant to § 287.135, Florida Statutes, the submission of a false certification may subject the company to civil penalties, attorney’s fees, and/or costs. I further understand that any contract with Halifax Health for goods or services of any amount may be terminated at the option of Halifax Health if the company (i) is found to have submitted a false certification, (ii) has been placed on the Scrutinized Companies that Boycott Israel List, or (iii) is engaged in a boycott of Israel. And, in addition to the foregoing, if the amount of the contract is one million dollars ($1,000,000) or more, the contract may be terminated at the option of Halifax Health if the company is found to have submitted a false certification, 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 has been engaged in business operations in Cuba or Syria.
Signature of Authorized Representative: ___________________________________________
Printed Name: _____________________________________________ Date:_____________
Title of Authorized Representative: ________________________________________________
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