6-Scrutinized Companies Form.pdf
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- Attached to
- Impact and Mobility Fee
- Solicitation number
- RFP No. 2026-003
- Issued by
- Palm Beach County, Florida
About this file
This is a Scrutinized Companies Certification form required by the Town of Palm Beach, Florida Purchasing Division for vendors bidding on the Impact and Mobility Fee consulting services contract. The form requires vendors to certify compliance with Florida statutes regarding boycotts of Israel, activities in Sudan, Iran's petroleum energy sector, and business operations in Cuba or Syria. The certification mandates that the company is not listed on any scrutinized companies lists established pursuant to Florida Statutes 215.4725, 215.473, or 287.135. The form requires the vendor or company representative to sign and date the certification, affirming under oath or affirmation that the company meets all specified criteria as of the submission date. The Town of Palm Beach seeks qualified firms to provide impact and mobility fee consulting services on an as-needed basis, with proposals submitted online through the Euna eProcurement platform. A non-mandatory pre-proposal conference will be held virtually via Microsoft Teams, with details provided in the Events section, and award will be made to the proposer offering the best value to the Town.
The certification form does not address pricing terms, set-asides, incumbent information, or funding sources, as it functions solely as a compliance and eligibility verification document. Submission of this form is a prerequisite for bid consideration, and vendors must complete and submit it as part of their proposal package. The Town reserves the right to reject any and all proposals and to waive non-material irregularities or technicalities at its discretion. No proposer may withdraw their proposal for a period of one hundred eighty days from submission.
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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 .