9-Scrutinized Companies Form.pdf
PDF 600 KB Posted
- Attached to
- Police Station Improvements
- Solicitation number
- ITB No. 2026-010
- Issued by
- Palm Beach County, Florida
About this file
This is a Scrutinized Company Certification form required by the Town of Palm Beach, Florida for vendor compliance with state divestment laws. The certification requires bidders to affirm that their company does not appear on any of Florida's Scrutinized Companies lists and is not participating in boycotts of Israel, does not have material business relationships with the governments of Sudan or Iran related to oil extraction or military equipment, does not appear on lists of companies with activities in Sudan or Iran's petroleum sector, and is not engaged in business operations in Cuba or Syria. The form references Florida Statutes 215.4725, 215.473, and 287.135, which establish the criteria and maintain the official scrutinized companies lists. Vendors must complete the form by providing their company name, signatory name and title, and date of certification.
This form is a mandatory compliance document that must be submitted as part of any bid response to the Town of Palm Beach for the Police Station Improvements project. Failure to complete and certify compliance with these divestment requirements would likely result in bid rejection or disqualification. The certification is a blanket requirement for all vendors bidding on Town of Palm Beach contracts and serves as the Town's mechanism to ensure compliance with Florida state law regarding investments and business relationships with designated countries and entities.
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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 .