6-[On-Call Pipelining and Drainage Repair Services] 3 BPM005628 SPO Form 205 - Forced Labor of Ethnic Uyghurs Ban.pdf

Procurement

ATTACHMENT 3

FORCED LABOR OF ETHNIC UYGHURS BAN

Solicitation No: BPM005628 Available online at https://app.az.gov

SPO Form 205 (rev 09-2022)

Forced Labor of Ethnic Uyghurs Ban Please note that if any of the following apply to the Contractor, then the Offeror shall select the “Exempt Contractor” option below:

Contractor is a sole proprietorship;

Contractor has fewer than ten (10) employees; OR Contractor is a non-profit organization.

Pursuant to A.R.S. § 35-394, the State of Arizona prohibits a public entity from entering into or renewing a contract with a company unless the contract includes written certification that the company does not use the forced labor, or any goods or services produced by the forced labor, of ethnic Uyghurs in the People's Republic of China.

Under A.R.S. §35-394:

1. "Company" means an organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, limited liability company or other entity or business association, including a wholly owned subsidiary, majority-owned subsidiary, parent company or affiliate, that engages in for-profit activity and that has ten or more full-time employees.

2. "Public entity" means this State, a political subdivision of this State or an agency, board, commission or department of this State or a political subdivision of this State.

In compliance with A.R.S. §§ 35-394 et seq., all offerors must select one of the following:

The Company submitting this Offer does not use, and agrees not to use during the term of the contract, any of the following:

Forced labor of ethnic Uyghurs in the People’s Republic of China;

Any goods or services produced by the forced labor of ethnic Uyghurs in the People’s Republic of China; or

Any Contractors, Subcontractors, or suppliers that use the forced labor or any goods or services produced by the forced labor of ethnic Uyghurs in the People’s Republic of China.

☐ The Company submitting this Offer does participate in use of Forced Uyghurs Labor as described in A.R.S. § 35-394.

Exempt Contractor.

Indicate which of the following statements applies to this Contractor (may be more than one):

☐ Contractor is a sole proprietorship;

☐ Contractor has fewer than ten (10) employees; and/or ☐ Contractor is a non-profit organization.

Company Name Signature of Person Authorized to Sign

Address Printed Name

City State Zip Title

Date x

Southwest Siteworks LLC

6727 N Silverbell RD

Tucson AZ 85743 President

9.20.23

Jacob Buckley https://app.az.gov/

Forced Labor of Ethnic Uyghurs Ban