9-09 - Texas Government Code Section 2252.pdf
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- Attached to
- SCADA Maintenance Services for Water Operations
- Solicitation number
- RFQ 25-18981-YB
- Issued by
- Henderson County, Texas
About this file
This document is a Texas Government Code Section 2252.152 certification form for the City of Lubbock Purchasing and Contract Department. The form requires a company representative to certify that their company is not listed on the Texas Comptroller's website as doing business with Iran, Sudan, or any Foreign Terrorist Organization. The signatory must also commit to immediately notifying the City of Lubbock Purchasing and Contract Department if their company enters into a contract with any entity on such a listing.
The form is a standard compliance document that allows companies to affirm their eligibility for government contracts by demonstrating they do not have business relationships with specified international entities deemed problematic by Texas state law. The document provides blank spaces for the company name, authorized signatory, printed name and title of the signatory, and date of signing. No specific contract, pricing, or procurement details are included in this form beyond the certification requirements.
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Text version
TEXAS GOVERNMENT CODE SECTION 2252.152
I, ______________________________________________, the undersigned representative of
________________________________________________ (Company or business name) being an adult over the age of eighteen (18) years of age, pursuant to Texas Government Code, Chapter 2252, Section 2252.152, certify that the company named above is not listed on the website of the Comptroller of the State of Texas concerning the listing of companies that are identified under Section 806.051, Section 807.051 or Section 2253.153. I further certify that should the above-named company enter into a contract that is on said listing of companies on the website of the Comptroller of the State of Texas, which do business with Iran, Sudan or any Foreign Terrorist
Organization, I will immediately notify the City of Lubbock Purchasing and Contract Department.
Company Name:
SIGNED BY:
Print Name & Title:
Date Signed:
| I: |
| Company or business name being an adult over the: |
| Company Name: |
| SIGNED BY: |
| Print Name: |
| Date Signed: |
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