9-Form - Scrutinized.pdf
PDF 77 KB Posted
- Attached to
- Property Appraiser Office Remodel (Rebid)
- Solicitation number
- 2027014
- Issued by
- Indian River County, Florida
About this file
This is a Certification Regarding Prohibition Against Contracting with Scrutinized Companies form required for submission with a bid or proposal for a Property Appraiser Office Remodel project in Florida. The form serves as a mandatory certification document for the rebid of an interior renovation project requiring all labor, materials, equipment, supervision, and incidentals necessary to complete the work.
The certifying entity must declare that neither it nor any of its 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 Statutes § 215.4725. For contracts valued at one million dollars or more, the certifying entity must additionally certify that it and its related entities 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 in § 215.473. The County reserves the right to immediately terminate any resulting contract upon written notice if the undersigned entity submits a false certification or is subsequently found to have violated any of these prohibitions. An authorized representative must sign the certification and provide the respondent name, signatory name and title, and date of certification.
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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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