8-Form - Scrutinized.pdf
PDF 77 KB Posted
- Solicitation number
- 2027007
- Issued by
- Indian River County, Florida
About this file
This is a certification form required for submission with bids and proposals to the State of Florida, specifically for a Sandridge Golf Course roof replacement project in Vero Beach, Florida. The project involves providing all labor, supervision, materials, equipment, and incidentals necessary to remove and replace the roof covering on cart barns at Sandridge Golf Course located at 5300 73rd Street, Vero Beach, FL 32967. The form must be completed and submitted by the respondent as part of the bidding requirements for this contract opportunity.
The certification form requires respondents to attest that neither their entity nor any wholly owned subsidiaries, majority-owned subsidiaries, parent companies, or affiliates have been placed on the Scrutinized Companies that Boycott Israel List or are engaged in a boycott of Israel pursuant to Florida Statute s. 215.4725. For contracts valued at one million dollars or more, respondents must additionally certify that they 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 engaged in business operations in Cuba or Syria as defined under s. 215.473. The County reserves the right to immediately terminate any resulting contract upon written notice if the respondent or any related entity is found to have submitted a false certification or is subsequently placed on any scrutinized companies list or found to be engaged in prohibited business operations.
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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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