4-Attachment D-Scrutinized Co Cert.pdf
PDF 185 KB Posted
- Attached to
- REVERSE OSMOSIS SYSTEM REPLACEMENT FOR TLSC SPD
- Solicitation number
- PROJ-25-163
- Issued by
- Volusia County, Florida
About this file
This document is a Vendors Certification form for Halifax Health, addressing Florida statutory requirements regarding scrutinized companies and their eligibility to bid on or enter into contracts. The certification specifically requires vendors to confirm they are not on lists of companies that boycott Israel, have activities in Sudan or Iran's petroleum sector, or conduct business operations in Cuba or Syria.
The document outlines specific legal restrictions: companies are prohibited from bidding on contracts if they are on certain scrutinized companies lists, with different thresholds for contracts under and over $1 million. Vendors must certify their compliance, understanding that submitting a false certification can result in civil penalties, potential contract termination, and legal consequences. The form requires vendors to provide their company details, contact information, and an authorized representative's signature, affirming their status regarding these international business restrictions.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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: ________________________________________________
| Text1: |
| Text2: |
| Text3: |
| Text4: |
| Text5: |
| Text6: |
| Text7: |
| Text8: |
| Text9: |
| Text10: |
| Text11: |
| Text12: |
| Text13: |
File details come from the government source that posted it. Updated .