5-Form - Scrutinized.pdf
PDF 77 KB Posted
- Attached to
- Annual Bid for 93% Sulfuric Acid
- Solicitation number
- 2027001
- Issued by
- Indian River County, Florida
About this file
This is a certification form regarding the prohibition against contracting with scrutinized companies, required for submission with bids or proposals to a Florida county for an annual bid to supply 93% sulfuric acid. The form mandates that respondents certify that neither they nor any of their wholly owned subsidiaries, majority-owned subsidiaries, parent companies, or affiliates have been placed on the Scrutinized Companies that Boycott Israel List or are engaged in a boycott of Israel pursuant to Florida Statutes Section 215.4725. For contracts valued at one million dollars or more, respondents must additionally certify that neither they nor related entities appear on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or are engaged in business operations in Cuba or Syria as defined by statute.
The county reserves the right to immediately terminate any resulting contract upon written notice if the respondent or related entity is found to have submitted a false certification or subsequently appears on any of the specified scrutinized companies lists, engages in a boycott of Israel, or conducts business operations in the prohibited jurisdictions. The form requires completion with the respondent's name, authorized signature, signatory name and title, date, and firm or entity information. This certification serves as a compliance requirement to ensure that state and local funds are not directed to entities engaged in boycotts or activities contrary to Florida's statutory prohibitions.
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Text version
CERTIFICATION REGARDING PROHIBITION AGAINST
CONTRACTING WITH SCRUTINIZED COMPANIES
(This form MUST be submitted with your bid/proposal/SOQ)
I hereby certify that neither the undersigned entity, nor any of its wholly owned subsidiaries, majority-owned subsidiaries, parent companies, or affiliates of such entities or business associations, that exists for the purpose of making profit have been placed on the Scrutinized Companies that Boycott Israel List created pursuant to s. 215.4725 of the Florida Statutes, or are engaged in a boycott of Israel.
In addition, if this solicitation is for a contract for goods or services of one million dollars or more, I hereby certify that neither the undersigned entity, nor any of its wholly owned subsidiaries, majority-owned subsidiaries, parent companies, or affiliates of such entities or business associations, that exists for the purpose of making profit are on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, created pursuant to s. 215.473 of the Florida Statutes, or are engaged in business operations in Cuba or Syria as defined in said statute.
I understand and agree that the County may immediately terminate any contract resulting from this solicitation upon written notice if the undersigned entity (or any of those related entities of respondent as defined above by Florida law) are found to have submitted a false certification or any of the following occur with respect to the company or a related entity: (i) it has been placed on the Scrutinized Companies that Boycott Israel List, or is engaged in a boycott of Israel, or (ii) for any contract for goods or services of one million dollars or more, it 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 it is found to have been engaged in business operations in Cuba or Syria.
Name of Respondent: ___________________________________
By: ________________________________________________ (Authorized Signature)
Name:
Title: ______________________________________________
Date:_____________________________
| Name: |
| Title: |
| Date: |
| Firm/Entity: |
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