8._CCHCS-MC-323-_Iran_Contracting_Act.pdf
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- Attached to
- Electrocardiograph (ECG) Equipment and Cardiologist Over-Read and Interpretation Services SD23-00094
- Solicitation number
- 0000033006
- Issued by
- California
About this file
The document is a certification form related to the Iran Contracting Act of 2010 for a California state contract opportunity. The form requires vendors to certify that they are not on the list of persons engaged in investment activities in Iran, as defined in the Act, or to provide information demonstrating an exemption from the certification requirement. Vendors must complete this certification prior to bidding on, submitting a proposal for, or executing a contract or renewal for a California state contract valued at $1 million or more. The form outlines the penalties for providing false certifications, including civil penalties, contract termination, and three-year ineligibility to bid on state contracts.
The document provides two options for vendors to comply with the certification requirement. Option 1 is a certification that the vendor is not on the list of persons engaged in investment activities in Iran. Option 2 allows vendors engaged in such activities to seek an exemption on a case-by-case basis, which requires providing documentation demonstrating the exemption approval.
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Proposal Number: SD23-00094
CCHCS-MC-323 – Iran Contracting Act Rev. 09/26/2018
IRAN CONTRACTING ACT
Per the Iran Contracting Act of 2010 (Public Contract Code sections 2202-2208), prior to bidding on, submitting a proposal or executing a contract or renewal for a state of California contract for goods or services of $1 million or more, a vendor must either: (1) certify it is not on the current list of persons engaged in investment activities in Iran created by the Department of General Services (DGS) and/or a vendor/financial institution extending $20 million or more in credit to another person, for 45 days or more, if that other person will use the credit to provide goods or services in the energy sector in Iran and is identified on the current list as a person engaging in investment activities in Iran created by DGS; or (2) demonstrate it has been exempted from the certification requirement for that solicitation or contract.
To comply with this requirement, please insert your vendor/financial institution name and Federal Employer Identification Number (FEIN) and complete one of the options below. Please note: California law establishes penalties for providing false certifications, including civil penalties equal to the greater of $250,000 or twice the amount of the contract for which the false certification was made, contract termination, and three year ineligibility to bid on contracts pursuant to Public Contract Code section 2205(a).
OPTION #1 – CERTIFICATION
I, the official named below, certify I am duly authorized to execute this certification on behalf of the vendor/financial institution identified below, and the vendor/financial institution identified below is not on the current list of persons engaged in investment activities in Iran created by DGS and is not a financial institution extending $20 million or more in credit to another person/vendor, for 45 days or more, if that other person/vendor will use the credit to provide goods or services in the energy sector in Iran and is identified on the current list of persons engaged in investment activities in Iran created by DGS.
Vendor Name/Financial Institution (Printed) Federal Employer Identification Number (FEIN)
By (Authorized Signature)
Printed Name and Title of Person Signing
Date Executed Executed in the County and State of
OPTION #2 – EXCEPTIONS
Pursuant to Public Contract Code section 2203(c)-(d), a public entity may permit a vendor/financial institution engaged in investment activities in Iran, on a case-by-case basis, to be eligible for, or to bid on, submit a proposal for, or enter into or renew, a contract for goods or services of $1 million or more with a public entity.
If you have obtained an exemption from the certification requirement under the Iran Contracting Act, please fill out the information below, and attach documentation demonstrating the exemption approval.
Vendor Name/Financial Institution (Printed) Federal Employer Identification Number (FEIN)
By (Authorized Signature)
Printed Name and Title of Person Signing
Date Executed Executed in the County and State of
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