8-Form - Scrutinized.pdf
PDF 77 KB Posted
- Attached to
- Sandridge Golf Club Bulkhead Replacement
- Solicitation number
- 2026022
- Issued by
- Indian River County, Florida
About this file
This is a certification form required for bid submission on the Sandridge Golf Club Bulkhead Replacement project in Florida. The form mandates that respondents certify compliance with Florida's scrutinized companies laws, specifically confirming that neither the bidding entity nor its subsidiaries, parent companies, or affiliates are listed on the Scrutinized Companies that Boycott Israel List or engaged in boycotts of Israel. For contracts valued at one million dollars or more, bidders must additionally certify that they and their related entities are not on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, and are not conducting business operations in Cuba or Syria as defined by Florida Statute 215.473.
The certification requires authorized signatures from the respondent entity, with identified signatories providing their names, titles, and dates. The County reserves the right to immediately terminate any resulting contract upon written notice if the bidder submits false certification or if the company or any related entity becomes listed on prohibited companies lists, engages in Israel boycotts, or operates in restricted countries or sectors. This form must be submitted with all bids, proposals, or statements of qualifications and represents a mandatory compliance requirement for participation in this Florida state and local contract opportunity.
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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:_____________________________
| Name: |
| Title: |
| Date: |
| Firm/Entity: |
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