Attachment 4 - Key Indvidual Certification.pdf
PDF 134 KB Posted
- Attached to
- Youth Employment for Migration Prevention Activity Federal contract opportunity
- Solicitation number
- 72052220R00001
About this file
This document contains a key individual certification form and information about a federal contract opportunity with USAID Honduras. The key individual certification form requires the signatory to attest that within the last ten years they have not been convicted of narcotics offenses, been a trafficker of controlled substances, or knowingly assisted such activities.
The federal contract opportunity is for a cost-plus-fixed-fee completion type contract with USAID Honduras over five years and three option periods. The purpose is to increase youth employment and prevent irregular migration through the Youth Employment for Migration Prevention Activity. The solicitation number is 72052220R00001 and responses are due based on standard federal procurement procedures.
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Text version
RFP No. 72052220R00001
ATTACHMENT 4
KEY INDIVIDUAL CERTIFICATIONS NARCOTICS OFFENSES and DRUG TRAFFICKING
Certificate can be accessed at http://inside.usaid.gov/ADS/200/20657m1.pdf http://inside.usaid.gov/ADS/200/20657m1.pdf
Mandatory Reference: 206 Supplementary Reference: N/A File Name: ads15/20657m1
KEY INDIVIDUAL CERTIFICATION
NARCOTICS OFFENSES AND DRUG TRAFFICKING
I hereby certify that within the last ten years:
1. I have not been convicted of a violation of, or a conspiracy to violate, any law or regulation of the United States or any other country concerning narcotic or psychotropic drugs or other controlled substances.
2. I am not and have not been an illicit trafficker in any such drug or controlled substance.
3. I am not and have not been a knowing assistor, abettor, conspirator, or colluder with others in the illicit trafficking in any such drug or substance.
Signature: ________________________ Date:
Name: ___________________________
Title/Position: ____________________________
Organization: _____________________________
Address: ________________________________
Date of Birth: ______________________________
NOTICE:
1. You are required to sign this Certification under the provisions of 22 CFR Part 140, Prohibition on Assistance to Drug Traffickers. These regulations were issued by the Department of State and require that certain key individuals of organizations must sign this Certification.
2. If you make a false Certification you are subject to U.S. criminal prosecution under 18 U.S.C. 1001.
File details come from the government source that posted it. Updated .