7l- Affidavit Discriminatory Vendor List.pdf
PDF 112 KB Posted
- Attached to
- Marine Turtle Conservation Program Services
- Solicitation number
- RFP2025-054
- Issued by
- Palm Beach County, Florida
About this file
This document is an Affidavit Pursuant to Florida Statute Section 287.134 issued by the City of Delray Beach. The affidavit requires vendors to certify that they are not on the discriminatory vendor list, which would prohibit them from submitting bids, proposals, or replies on contracts with public entities. Vendors who are on this list are barred from providing goods or services, participating in public construction or repair projects, leasing real property, or transacting business with any public entity.
The document serves as a legal certification form that vendors must complete, affirming under penalty of perjury that they have not been placed on the discriminatory vendor list. The form requires vendors to provide their company name, Federal Employer Identification Number (FEIN), authorized representative details, contact information, and includes spaces for an authorized signature and date. By signing, the vendor representative attests to the accuracy of the information and confirms the company's eligibility to bid on or perform work for public entities in Florida.
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Text version
CITY OF DELRAY BEACH
Affidavit Pursuant to Fla. Stat. Section 287.134
Pursuant to Section 287.134, Florida Statutes, an entity or affiliate who has been placed on the discriminatory vendor list 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. By execution of this Agreement, Contractor represents that it has not been placed on the discriminatory vendor list as provided in Section 287.134, Florida Statutes.
As the officer or representative of the company, I certify that the company identified above:
1. is not on the discriminatory vendor list as provided by Florida Statute §287.134
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 .