9-Attachment B-Proposers Cert.pdf
PDF 89 KB Posted
- Attached to
- History Wall
- Solicitation number
- PROJ-26-079
- Issued by
- Volusia County, Florida
About this file
This is a Proposer's Certification form for Halifax Health Medical Center in Florida. The document serves as a binding attestation by vendors responding to Halifax Health's solicitation for a museum-quality static history wall commemorating the organization's 100-year anniversary. Proposers executing this certification affirm receipt of complete proposal documents and commit to adhering to all contained information. The certification requires authorized corporate officials to sign and provide company contact details, including telephone and email information, to facilitate contract administration and communication throughout the procurement process.
The certification encompasses several mandatory compliance representations, including attestations that proposers have not engaged in collusion or unethical practices with Halifax Health personnel, comply with federal, state, and local equal opportunity employment laws, maintain written sexual harassment policies consistent with applicable regulations, and will abide by all federal, state, and local codes and statutes. Additionally, proposers must certify their tax compliance status with the Florida Department of Revenue and confirm they are not debarred from contracting with Florida local government units due to tax delinquencies, unless actively contesting such assessments through appropriate statutory procedures. The certification requires notarization and must be dated and executed by an authorized representative of the proposing entity.
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Text version
ATTACHMENT D
HALIFAX HEALTH MEDICAL CENTER
PROPOSER’S CERTIFICATION
I/We hereby certify that:
A. A complete set of proposal papers, as intended, has been received, and I/We will abide by the contents and/or information received and/or contained herein.
B. I/We have not entered into any collusion or other unethical practices with any person, firm, or employee of Halifax Health which would in any way be construed as unethical practice.
C. I/We comply with all current federal, state and local laws, statutes, rules, and regulations referencing equal opportunity employment practices.
D. I/We have adopted a written sexual harassment policy which is in accordance with the requirements of federal, state and local laws, regulations and policies.
E. I/We will abide by all other federal, state and local codes, rules, regulations, ordinances and statutes.
COMPANY NAME
ADDRESS
DISTRICT/STATE/ZIP CODE
NAME OF CORPORATE/COMPANY OFFICIAL
(PLEASE TYPE OR PRINT CLEARLY)
TITLE
AUTHORIZED REPRESENTATIVES SIGNATURE
DATE
TELEPHONE ( )
HALIFAX HEALTH MEDICAL CENTER
STATE OF FLORIDA
COUNTY OF
PROPOSER’S TAX CERTIFICATION
(PROPOSERS AUTHORIZED REPRESENTATIVE),
being first duly sworn on oath, deposes and states that all statements made herein are made on behalf of the Proposer, that this respondent is authorized to make them and that the statements contained herein are true and correct. Proposer deposes, states and certifies that Proposer is not barred from contracting with any unit of local government in the State of Florida as result of a delinquency in payment of any tax administered by the Florida Department of Revenue unless Proposer is contesting, in accordance with the procedures established by the appropriate statute, its liability for the tax or the amount of the tax.
DATED this day of , 2025.
By (Authorized Representative Signature)
(Print Name of Authorized Representative)
(Title)
ATTEST/WITNESS:
By
Title
Subscribed and sworn to before me this day of , 2025.
Notary Public
(SEAL)
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