Attachment_6_-_Darfur_Contracting_Act_Certification.docx

RFP Title: Voluntary Benefits RFP Number: 24-01

ATTACHMENT 6

darfur contracting act certification Pursuant to Public Contract Code (PCC) section 10478, if a Bidder currently or within the previous three years has had business activities or other operations outside of the United States, it must either (i) certify that it is not a “scrutinized company” as defined in PCC 10476, or (ii) receive written permission from the Court to submit a proposal.

To submit a proposal to USI, the Bidder must insert its company name and Federal ID Number below and complete ONLY ONE of the following three paragraphs. To complete paragraph 1 or 2, simply check the corresponding box. To complete paragraph 3, check the corresponding box and complete the certification for paragraph 3.

Printed Name and Title of Person Checking Box (for paragraph 1 or 2 below)

1. We do not currently have, and we have not had within the previous three years, business activities or other operations outside of the United States.

OR

2. We are a “scrutinized company” as defined in PCC 10476, but we have received written permission from the Court to submit a proposal pursuant to PCC 10477(b). A copy of the written permission from the Court is included with our proposal.

OR

3. We currently have, or we have had within the previous three years, business activities or other operations outside of the United States, but we certify below that we are not a “scrutinized company” as defined in PCC 10476.

CERTIFICATION FOR PARAGRAPH 3:

I, the official named below, CERTIFY UNDER PENALTY OF PERJURY, that I am duly authorized to legally bind the Bidder to the clause in paragraph 3. This certification is made under the laws of the State of California.

Printed Name and Title of Person Signing:

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