8-Scrutinized Companies Form.pdf
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- Solicitation number
- SS No. 2026-22
- Issued by
- Palm Beach County, Florida
About this file
This document is a Scrutinized Company Certification form required by the Town of Palm Beach, Florida for vendor participation in a sole source procurement for an MVB3X Modular Vehicle Barrier System from Advanced Security Technologies LLC (AST). The certification requires vendors to affirm compliance with Florida Statutes 215.4725, 215.473, and 287.135 regarding restrictions on business activities with certain countries and entities. Vendors must certify that they are not participating in boycotts of Israel, do not appear on Scrutinized Companies lists related to Sudan, Iran's petroleum sector, and are not engaged in business operations in Cuba or Syria. The form requires the vendor or company representative to provide their name, title, signature, and date of certification. Questions regarding the solicitation should be directed to Duke Basha, Assistant Procurement and Contract Manager, at dbasha@townofpalmbeach.com or (561) 227-7001, with all communications handled through the designated procurement representative due to cone of silence requirements.
The Town of Palm Beach reserves the right to award the contract in its entirety or in part and may accept or reject bids based on the solicitation criteria. No specific pricing information, set asides, incumbent vendor details, funding sources, or contract term details are provided in this certification form. The document serves as a compliance verification requirement rather than addressing financial or contractual terms, which are referenced as being contained in attached scope of services and specifications documents.
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Text version
11/16/18
Scrutinized Company Certification
1. This company is not participating in a boycott of Israel such that it is not refusing to deal, terminating business activities, or taking other actions to limit commercial relations with Israel, or persons or entities doing business in Israel or in Israeli-controlled territories, in a discriminatory manner.
2. This Company does not appear on the Scrutinized Companies with Activities in Sudan List where the
State Board of Administration has established the following criteria:
a. Have a material business relationship with the government of Sudan or a government-created project involving oil related, mineral extraction, or power generation activities, or
b. Have a material business relationship involving the supply of military equipment, or
c. Impart minimal benefit to disadvantaged citizens that are typically located in the geographic periphery of Sudan, or
d. Have been complicit in the genocidal campaign in Darfur.
3. This Company does not appear on the Scrutinized Companies with Activities in the Iran Petroleum
Energy Sector List where the State Board of Administration has established the following criteria:
a. Have a material business relationship with the government of Iran or a government-created project involving oil related or mineral extraction activities, or
b. Have made material investments with the effect of significantly enhancing Iran‘s petroleum sector.
4. This Company is not engaged in business operations in Cuba or Syria.
VENDOR/COMPANY NAME:
NAME:
TITLE:
SIGNATURE:
DATE:
TOWN OF PALM BEACH
PURCHASING DIVISION
951 Okeechobee Road Suite D West Palm Beach, Florida 33401
Telephone: (561) 838-5406
PURCHASING DIVISION
951 Okeechobee Road Suite D West Palm Beach, Florida 33401
Telephone: (561) 838-5406 Facsimile (561) 835-4688 Website: www.townofpalmbeach.com
I hereby swear or affirm that as of the date below this company is not listed on a Scrutinized Companies list created pursuant to 215.4725, 215.473, or 287.135, Florida Statutes. Pursuant to 287.135, Florida Statutes I further affirm that:
http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0200-0299/0215/Sections/0215.4725.html http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0200-0299/0215/Sections/0215.4725.html http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0200-0299/0287/Sections/0287.135.html
| VENDORCOMPANY NAME: |
| Name: |
| Title: |
| Signiture: |
| Date: |
File details come from the government source that posted it. Updated .