Attachment 2_Anti-Mafia Certification.pdf
PDF 248 KB Posted
- Solicitation number
- W912PF-26-R-A005
About this file
This is a Self-Certification for Antimafia Communication, a substitutive certification declaration under Italian law (D.P.R. n. 445 del 28.12.2000). The document is a template used in Italian contracting procedures that requires the signatory to declare their personal and professional information, including full name, tax identification number (C.F.), birthplace, residence address, job title, and company details including company name, tax identification number, and registered address.
The declarant certifies under penalty of perjury that they do not fall under any prohibitive causes, forfeiture conditions, or suspension grounds as outlined in Article 67 of Legislative Decree No. 159 of September 6, 2011 (the Italian Anti-Mafia Code). The declarant also acknowledges awareness of personal data protection obligations under D.Lgs. n. 196/2003 and consents to the processing of their personal data exclusively for the purpose of the specific procedure for which the declaration is submitted. The document requires the declarant's signature and date. This is a template form with blank fields for completion and is not specific to any particular federal contract opportunity or product/service requirement.
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Other files
| File | Type | Posted |
|---|---|---|
| Solicitation Amendment W912PF26RA0050003 SF 30 1.pdf | ||
| Solicitation Amendment W912PF26RA0050002 SF 30.pdf | ||
| ACS Q-A Update.xlsx | XLSX spreadsheet | |
| Attachment 4_PWS update.pdf | ||
| ACS Q-A.xlsx | XLSX spreadsheet | |
| Solicitation Amendment W912PF26RA0050001 SF 30.pdf | ||
| Solicitation W912PF26RA005.pdf | ||
| Attachment 1-Pricing Schedule.xlsx | XLSX spreadsheet | |
| Attachment 3_Suitability of the Contractor.pdf | ||
| Attachment 4_PWS.pdf |
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Text version
Self-certification for Antimafia communication
Autocertificazione della comunicazione antimafia
Dichiarazione sostitutiva di certificazione (D.P.R. n. 445 del 28.12.2000)
Il/la sottoscritto/a (nome e cognome) _______________________________ C.F._________________ nato/a _______________________________ Prov. _________ il ______________ residente a
________________________ Prov. _____ in via/piazza ____________________
_______________________________ n. ____, in qualità di (carica ricoperta) ___________ dell’impresa (indicare la denominazione) _______________________________________________ C.F. __________________ avente la sede in _________________________ Prov. di __________ Via ___________________________ n. ______ consapevole delle sanzioni penali in caso di dichiarazioni false e della conseguente decadenza dai benefici eventualmente conseguiti (ai sensi degli artt. 75 e 76 D.P.R. 445/2000) sotto la propria responsabilità
DICHIARA
che nei propri confronti non sussistono le cause di divieto, di decadenza o di sospensione di cui all’art. 67 del D.lgs. n. 159 del 06/09/2011.
Il/la sottoscritto/a dichiara inoltre di essere informato/a, ai sensi del D.Lgs. n. 196/2003 (codice in materia di protezione di dati personali) che i dati personali raccolti saranno trattati, anche con strumenti informatici, esclusivamente nell’ambito del procedimento per il quale la presente dichiarazione viene resa.
data firma leggibile del dichiarante (2)
File details come from the government source that posted it. Updated .