Attachment 4 - Self Certification Antimafia Communication.pdf

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Perform Inspections and Tests for Electrical Distribution Systems at USAG Italy
Solicitation number
W912PF24Q0078
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The provided document is a Self-Certification for Antimafia Communication, which is a declaration made by the signatory stating that there are no grounds for banning, forfeiting, or suspending the signatory under Article 67 of Legislative Decree No. 159 of 06/09/2011. This form is likely required as part of the federal contract opportunity detailed in the related information.

The federal contract opportunity is a Request for Quotation (RFQ) for Performing Inspections and Tests for Electrical Distribution Systems at USAG Italy DMC Buildings and Plants, in accordance with Italian DPR n 462/2001. The contractor must be an organization certified by the "Ministero dello Sviluppo Economico" to perform periodic checks on electrical systems per Italian law. The contractor will be required to verify, identify, and certify the safety level of the electrical and grounding systems for the specified buildings and structures. The performance period is 15 July - 31 December 2024, and this is a Firm-Fixed Price type contract. To be awarded the contract, the vendor must have a NCAGE number and be registered in the System for Award Management (SAM) website.

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B08-W912P24Q0078_AMD0001_Tests on Grounding Systems_Amd_20240516.pdf PDF
B08-W912P24Q0078_AMD0001_Tests on Grounding Systems_Conform_20240516.pdf PDF
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Attachment 3 - DUVRI.pdf PDF

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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 .