Attachment 4 - Key Indvidual Certification.pdf
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- Solicitation number
- 72052221R00001
About this file
This document includes an attachment for a key individual certification and information on a related federal contract opportunity. The attachment is a certification form requiring a signature from key individuals of organizations, certifying they have not been convicted of narcotics offenses or been involved in drug trafficking within the last ten years.
The related federal contract opportunity is a five-year cost-plus-fixed-fee completion contract being issued by USAID Honduras. The purpose is to implement the Feed the Future Honduras Food Security and Agriculture Resilient Market Systems Activity to strengthen agricultural market systems and reduce poverty in Honduras by making the systems more competitive, inclusive and resilient. The solicitation number is 72052221R00001 and proposals are being accepted to implement the activity.
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Text version
RFP No. 72052221R00001
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 .