5-Scrutinized Companies Form.pdf
PDF 600 KB Posted
- Attached to
- Compacted Garbage Collection and Disposal State and local contract opportunity
- Solicitation number
- ITB No. 2026-021
- Issued by
- Palm Beach County, Florida
About this file
This is a Scrutinized Company Certification form required by the Town of Palm Beach, Florida for vendors participating in the compacted garbage collection and disposal solicitation. The certification document requires vendors to affirm compliance with Florida Statutes regarding international business operations and sanctions. Bidders must confirm that their company is not participating in a boycott of Israel, does not appear on the Scrutinized Companies with Activities in Sudan List, does not appear on the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, and is not engaged in business operations in Cuba or Syria. The form references Florida Statutes 215.4725, 215.473, and 287.135, and requires the vendor to swear or affirm under penalty of law that the company is not listed on any scrutinized companies list as of the certification date. The form must be completed with the vendor/company name, signatory name and title, and date of certification.
The certification is a mandatory compliance document that must be submitted as part of the bid process for the Town of Palm Beach's compacted garbage collection and disposal services contract. All vendors responding to the invitation to bid are required to complete and submit this form to demonstrate that they meet the state's ethical sourcing and international relations compliance requirements prior to award consideration.
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Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| 4-Contact Info Form.pdf | ||
| 7-Protest Procedure Form.pdf | ||
| 11-Affidavit of Compliance with Foreign Entity and Human Trafficking.pdf | ||
| 15-ITB No. 2026-021 - Scope of Services.pdf | ||
| 13-Town of Palm Beach Insurance Requirements - Risk Type 1 - Standard Contracts and Minor Construction.pdf | ||
| 14-Liquidated Damages Form.pdf | ||
| 10-Reference Form.pdf | ||
| 6-Minimum Qualification Form.pdf | ||
| 2-Drug Free Workplace Form.pdf | ||
| 1-Subcontractors Form.pdf | ||
| 12-ITB revised - Terms and Conditions - Goods and Services.pdf | ||
| 9-E-Verify Form.pdf | ||
| 3-Bidder’s Qualification Form.pdf | ||
| 8-FS 119.0701 and FS 119.071 for Public Records 2024 version.pdf |
Show all 14
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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 .