5-Scrutinized Companies Form.pdf
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- Attached to
- RFQ No. 2026-013 Owner's Representative Services for Mid-Town Construction Projects State and local contract opportunity
- Solicitation number
- 2026-013
- Issued by
- Palm Beach County, Florida
About this file
This is a Scrutinized Company Certification form required by the Town of Palm Beach Purchasing Division for vendor participation in state and local contract opportunities in Florida. The certification pertains to RFQ No. 2026-013 for Owner's Representative Services for Mid-Town Construction Projects. Vendors must certify their compliance with Florida Statutes 215.4725, 215.473, and 287.135 regarding restrictions on business activities in specific countries and regions. The certification requires vendors to affirm they are not participating in boycotts of Israel, do not appear on the Scrutinized Companies with Activities in Sudan List, do not appear on the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, and are not engaged in business operations in Cuba or Syria. The form must be signed and dated by an authorized company representative and submitted to the Town of Palm Beach Purchasing Division located at 951 Okeechobee Road Suite D, West Palm Beach, Florida 33401.
This certification document does not contain pricing terms, set-asides, or funding information. Rather, it serves as a mandatory compliance document that all vendors must complete and submit as a condition of proposal eligibility. The form is a prerequisite for vendors bidding on the Mid-Town construction projects, which include the Seawall Replacement project, Linear Park construction, Bathroom Renovation, and Paving and Infrastructure Improvements. Vendors who fail to provide accurate certification or who appear on any of the specified scrutinized company lists would be deemed non-responsive and ineligible for contract award.
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Text version
11/16/18
Scrutinized Company Certification
1. This company is not participating in a boycott of Israel such that it is not refusing to deal, terminating business activities, or taking other actions to limit commercial relations with Israel, or persons or entities doing business in Israel or in Israeli-controlled territories, in a discriminatory manner.
2. This Company does not appear on the Scrutinized Companies with Activities in Sudan List where the
State Board of Administration has established the following criteria:
a. Have a material business relationship with the government of Sudan or a government-created project involving oil related, mineral extraction, or power generation activities, or
b. Have a material business relationship involving the supply of military equipment, or
c. Impart minimal benefit to disadvantaged citizens that are typically located in the geographic periphery of Sudan, or
d. Have been complicit in the genocidal campaign in Darfur.
3. This Company does not appear on the Scrutinized Companies with Activities in the Iran Petroleum
Energy Sector List where the State Board of Administration has established the following criteria:
a. Have a material business relationship with the government of Iran or a government-created project involving oil related or mineral extraction activities, or
b. Have made material investments with the effect of significantly enhancing Iran‘s petroleum sector.
4. This Company is not engaged in business operations in Cuba or Syria.
VENDOR/COMPANY NAME:
NAME:
TITLE:
SIGNATURE:
DATE:
TOWN OF PALM BEACH
PURCHASING DIVISION
951 Okeechobee Road Suite D West Palm Beach, Florida 33401
Telephone: (561) 838-5406
PURCHASING DIVISION
951 Okeechobee Road Suite D West Palm Beach, Florida 33401
Telephone: (561) 838-5406 Facsimile (561) 835-4688 Website: www.townofpalmbeach.com
I hereby swear or affirm that as of the date below this company is not listed on a Scrutinized Companies list created pursuant to 215.4725, 215.473, or 287.135, Florida Statutes. Pursuant to 287.135, Florida Statutes I further affirm that:
http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0200-0299/0215/Sections/0215.4725.html http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0200-0299/0215/Sections/0215.4725.html http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0200-0299/0287/Sections/0287.135.html
| VENDORCOMPANY NAME: |
| Name: |
| Title: |
| Signiture: |
| Date: |
File details come from the government source that posted it. Updated .