7-Scrutinized Companies Form.pdf

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Attached to
Elevator Maintenance and Inspection
Solicitation number
ITB No. 2025-030
Issued by
Palm Beach County, Florida

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This document is a Scrutinized Company Certification form from the Town of Palm Beach Purchasing Division, located in West Palm Beach, Florida. The form requires vendors to certify that they are not engaged in certain business activities deemed problematic by Florida Statutes, specifically related to interactions with Israel, Sudan, Iran, Cuba, and Syria. The certification involves four key declarations: (1) the company is not boycotting Israel, (2) the company does not appear on the Scrutinized Companies with Activities in Sudan List, (3) the company does not appear on the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, and (4) the company is not conducting business operations in Cuba or Syria.

The certification is designed to ensure that vendors doing business with the Town of Palm Beach comply with specific state regulations regarding international business relationships. Vendors must complete the form by providing their company name, a representative's name and title, and signing and dating the document. The form references Florida Statutes 215.4725, 215.473, and 287.135, which outline the criteria for scrutinizing companies based on their international business activities. By signing this document, vendors affirm that they meet these statutory requirements and are eligible to contract with the Town of Palm Beach.

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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 .