Attachment 4 Self Certification for Antimafia Communication Ungulate Control.pdf

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Attached to
Ungulate Control Service at DMC, Tirrenia, Pisa
Solicitation number
W912PF25QUNGU
Issued by

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This document is a Self-certification for Antimafia Communication form associated with the Ungulate Control Service solicitation W912PF25QUNGU. The form is a standard Italian legal self-declaration document where an individual certifies that they do not have any disqualifying conditions under Article 67 of Legislative Decree 159/2011, which relates to anti-mafia regulations. The form requires the declarant to provide personal details, company information, and includes a privacy consent statement for data processing under Italian law (D.Lgs. n. 196/2003). The form is designed to be completed by a company representative and requires a signature and date to validate the self-certification.

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Attachment 2 Performance Work Statement Ungulate Control Rev 1.pdf PDF
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Attachment 6 Standard Operating Procedures Ungulate Control.pdf PDF
Attachment 3 Experience Questionnaire Ungulate Control.docx DOCX document
Attachment 1 Pricing Worksheet Ungulate Control.xlsx XLSX spreadsheet
Attachment 7 Hazards General List Ungulate Control.pdf PDF
Attachment 5 DUVRI Ungulate Control.pdf PDF
Attachment 2 Perfomance Work Statement Ungulate Control.pdf PDF
Combo Synopsis Solicitation Ungulate Control Service.pdf PDF

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UNGU

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 .