6-Form - Scrutinized.pdf
PDF 77 KB Posted
- Attached to
- RFQ for Attainable Housing Trust Fund Services
- Solicitation number
- 2026025
- Issued by
- Indian River County, Florida
About this file
This is a certification form regarding prohibition against contracting with scrutinized companies, required as part of a Request for Qualifications (RFQ) for Attainable Housing Trust Fund Services issued by a Florida county government. The RFQ seeks qualified partners to construct, improve, rehabilitate, maintain, and oversee affordable housing units, each subject to a 50-year Land Use Restriction Agreement (LURA). Respondents may submit for prequalification in rehabilitative projects, new construction projects, or both. Potential respondents and their agents are prohibited from communicating with the Board of Commissioners, Affordable Housing Assistance Committee, County Administrator, or any county staff other than procurement personnel regarding this solicitation from the time of RFQ issuance until the Board of County Commissioners authorizes final award, with violation resulting in potential disqualification.
The certification form requires respondents to verify that neither they nor their wholly owned subsidiaries, majority-owned subsidiaries, parent companies, or affiliates have been placed on Florida's Scrutinized Companies that Boycott Israel List or are engaged in a boycott of Israel. For contracts valued at one million dollars or more, respondents must additionally certify that they and related entities are not on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, and are not engaged in business operations in Cuba or Syria. The county reserves the right to immediately terminate any resulting contract upon written notice if the respondent submits a false certification or if the respondent or a related entity is subsequently found to have violated these requirements.
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Other files
| File | Type | Posted |
|---|---|---|
| 3-Form - Disclosure Form.pdf | ||
| 7-Form - Lobbying.pdf | ||
| 4-Form - Foreign Entity Ownership.pdf | ||
| 5-Form - Anti-Human Traffic.pdf | ||
| 2-Request for Qualifications Package.pdf | ||
| 1-Form - RFQ Compliance.pdf |
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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: |
File details come from the government source that posted it. Updated .