7-Form - Scrutinized.pdf
PDF 77 KB Posted
- Attached to
- Annual Bid for Liquid Carbon Dioxide
- Solicitation number
- 2026023
- Issued by
- Indian River County, Florida
About this file
This is a certification form regarding prohibition against contracting with scrutinized companies, applicable to a Florida county procurement for annual liquid carbon dioxide supply. The form must be submitted with all bid submissions and requires authorized signatures from respondents certifying that neither the bidding entity nor any of its subsidiaries, parent companies, or affiliates have been placed 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, bidders must also certify that neither they nor related entities appear on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, nor are they engaged in business operations in Cuba or Syria.
The county reserves the right to immediately terminate any resulting contract upon written notice if a respondent submits a false certification or if the bidding entity or any related entity is subsequently found to have been placed on any of the aforementioned scrutinized companies lists or engaged in prohibited business operations. Compliance with Florida Statutes sections 215.4725 and 215.473 is mandatory for contract award consideration.
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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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