8-Scrutinized Companies Form.pdf
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- Solicitation number
- ITB No. 2026-024
- Issued by
- Palm Beach County, Florida
About this file
This is a Scrutinized Companies Certification Form required by the Town of Palm Beach, Florida for vendors bidding on the A39, A42, and A43 Pump Station Ventilation Improvements project. The form mandates vendor compliance with Florida Statutes sections 215.4725, 215.473, and 287.135 regarding prohibited business activities and investments. Bidders must certify that their company is not participating in boycotts of Israel, does not appear on the Scrutinized Companies with Activities in Sudan List, does not appear on the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, and is not engaged in business operations in Cuba or Syria. The certification must be signed and dated by an authorized company representative and submitted as part of the bid package through the Town's eProcurement platform (Euna Procurement/Bonfire).
This form serves as a prerequisite compliance document and does not contain pricing information, set-asides, or contract terms. All contractors submitting bids for this ventilation improvements project must complete and submit this certification to be considered responsive bidders. The form is administered by the Town of Palm Beach Purchasing Division and references Florida statutory requirements designed to ensure that public funds are not directed toward companies engaged in activities deemed contrary to state policy interests.
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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 .