6-Form - Scrutinized.pdf
PDF 77 KB Posted
- Attached to
- Round Island Shelters Columns Replacement
- Solicitation number
- 2027006
- Issued by
- Indian River County, Wilton Manors City, Florida
About this file
This is a Certification Regarding Prohibition Against Contracting with Scrutinized Companies form required for submission with bids and proposals to a Florida county government entity. The form applies to the Round Island Shelters Columns Replacement project in Vero Beach, Florida, which involves replacing thirty deteriorated poured-concrete structural columns at five existing picnic pavilions (six columns per pavilion) at Round Island Park. The project requires all labor, supervision, materials, equipment, temporary supports, disposal, testing, protection, and incidental work necessary to complete the column replacement in compliance with approved construction plans, issued permits, Florida Building Code requirements, and all applicable federal, state, and local regulations.
The certification form requires the respondent to attest that neither the bidding entity nor any of its wholly owned subsidiaries, majority-owned subsidiaries, parent companies, or for-profit affiliates appear on the Scrutinized Companies that Boycott Israel List or are engaged in a boycott of Israel. For contracts valued at one million dollars or more, the certification additionally requires that the respondent 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 related entities are subsequently found to have been placed on any of these lists or engaged in prohibited business activities.
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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:_____________________________
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