5-Anti-Discrimination Against Israel Affidavit.pdf
PDF 99 KB Posted
- Solicitation number
- 26-109
- Issued by
- Missouri
About this file
This is an affidavit of compliance document related to Missouri's Anti-Discrimination Against Israel Act, applicable to state and local contracts exceeding $100,000 with companies employing ten or more individuals. The affidavit requires authorized representatives of bidding entities to swear under oath that their business is not currently engaged in and will not engage in a boycott of goods or services from the State of Israel, Israeli-authorized or licensed companies, or entities conducting business in or with Israel throughout the contract duration. The document must be notarized and submitted as part of the proposal package, with the affiant confirming they are signing as the free act and deed of the business entity without duress.
This compliance affidavit applies to the City of Alpharetta's North Park Lighting Project (RFP 26-109), a substantial infrastructure upgrade funded in part through Land & Water Conservation Fund grant money, which triggers additional federal compliance requirements under 2 C.F.R. 200 and Build America, Buy America regulations. Proposers must submit the affidavit along with other mandatory documentation including a 5% bid bond, IRS Form W-9, Bidder's Disclosures and Certifications, and an E-Verify affidavit. The project requires performance and payment bonds at 100% of total contract price and comprehensive insurance coverage including $1,000,000 Commercial General Liability and $2,000,000 Commercial Umbrella Liability per occurrence. Contractors must comply with federal and state nondiscrimination laws including Title VI of the Civil Rights Act and the Americans with Disabilities Act.
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Other files
| File | Type | Posted |
|---|---|---|
| 3-Federal Work Authorization Program (1).pdf | ||
| 1-Appendix A.pdf | ||
| 2-Terms and Conditions.pdf | ||
| 4-AffidavitofNonCollusion (1).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:
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