7d- Notification and Affidavit of Public Entity Crimes Convicted Vendor List.pdf
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- Attached to
- Marine Turtle Conservation Program Services
- Solicitation number
- RFP2025-054
- Issued by
- Palm Beach County, Florida
About this file
This document is a Notification and Affidavit form from the City of Delray Beach, Florida, specifically related to vendor compliance with Florida Statute Section 287.133(2)(a) regarding public entity crimes. The form requires vendors to certify that they have not been placed on the convicted vendor list and are therefore eligible to submit bids, proposals, or replies for public contracts.
The affidavit outlines strict restrictions for vendors who have been convicted of public entity crimes, including a 36-month prohibition on submitting bids, performing contract work, or transacting business with public entities above a specified threshold amount. Vendors must affirm under penalty of perjury that they are not on the convicted vendor list, have been notified of these provisions, and have not been on such a list for the past 36 months prior to submitting any bid or proposal. The form provides space for vendors to enter their company details, including name, Federal Employer Identification Number (FEIN), authorized representative information, contact details, and signature.
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Text version
CITY OF DELRAY BEACH
Notification and Affidavit Pursuant to Fla. Stat. Section 287.133(2)(a)
A person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity; may not submit a bid, proposal, or reply on a contract with a public entity for the construction or repair of a public building or public work; may not submit bids, proposals, or replies on leases of real property to a public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity; and may not transact business with any public entity in excess of the threshold amount provided in s.
287.017 for CATEGORY TWO for a period of 36 months following the date of being placed on the convicted vendor list. As the officer or representative of the company, I certify that the Proposer and its affiliates:
1. Have been notified of the above provision,
2. are not on the convicted vendor list as provided by Florida Statute §287.133(2)(a); and
3. have not been on the convicted vendor list for a period of 36 months prior to submission of the bid, proposal, or reply.
Under penalty of perjury, I declare that I have read the foregoing document, and the facts stated in it are true.
Signature: ______________________________________________________
(Authorized Signature)
Print Name and Title _____________________________________________
Date:__________________________________________________________
Vendor Name:
Vendor FEIN:
Vendor’s
Authorized
Representative
Name and Title:
Address:
City: State: Zip:
Phone Number:
Email Address:
File details come from the government source that posted it. Updated .