Attachment D Iran Economic Sanctions Act Certification.pdf
PDF 39 KB Posted
- Attached to
- GenNET Firewall Maintenance RFP
- Solicitation number
- RFP-GIS-250000002479-1
- Issued by
- Genesee County, Flint City, Michigan
About this file
This document is an Iran Economic Sanctions Act Certification form for the Genesee Intermediate School District (GISD), located in Flint, Michigan, specifically for the Erwin L. Davis Education Center. The certification is required under Public Act 517 of 2012, and serves as a mandatory compliance document for potential contractors or vendors seeking to bid on services for the school district. The form requires bidders to certify that they are not an "Iran-linked business" as defined by the Act, with clear warnings about potential consequences for submitting false certifications, including contract termination, three-year bidding ineligibility, and substantial financial penalties.
The certification form provides a structured template for contractors to declare their compliance, requiring details such as the bidder's name, address, contact information, and authorization signature. The document emphasizes the legal implications of the certification, stipulating that any bids submitted without this completed form will be automatically rejected. The primary purpose is to ensure that the Genesee Intermediate School District does not engage with businesses that have economic ties to Iran, in alignment with state-level economic sanctions legislation.
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Text version
Attachment D
GENESEE INTERMEDIATE SCHOOL DISTRICT
ERWIN L. DAVIS EDUCATION CENTER
2413 WEST MAPLE AVENUE
FLINT, MI 48507-3493
PUBLIC ACT 517 OF 2012
IRAN ECONOMIC SANCTIONS ACT CERTIFICATION
I am the __________________of __________________, or I am bidding in my individual capacity ("Bidder"), with authority to submit a binding bid for the provision of Click here to enter text. services to Genesee Intermediate School District. I have personal knowledge of the matters described in this Certification, and I am familiar with the Iran Economic Sanctions Act, MCL 129.311, et seq. ("Act"). I am fully aware that the school district will rely on my representations in evaluating bids.
I certify that Bidder is not an Iran-linked business, as that term is defined in the Act. I understand that submission of a false certification may result in contract termination, ineligibility to bid for three (3) years, and a civil penalty of $250,000 or twice the bid amount, whichever is greater, plus related investigation and legal costs.
Any bids that do not include this Certification shall not be accepted.
Owner Name & Address:
Genesee Intermediate School District 2413 West Maple Avenue
Flint, MI 48507-3493
Contractor/Vendor/Respondent Information:
Name: ______________________________________________________________________
Address: ____________________________________________________________________
( )Contact Number: ______________________________________________________________
Person Authorized to Bind the Contractor/Vendor/Respondent:
Print Name Title
Signature Date
Accessibility Report
Filename:
Attachment D Vendor Certification_.pdf
Report created by:
Organization:
[Enter personal and organization information through the Preferences > Identity dialog.]
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| Name: |
| Address: |
| Print Name: |
| Title: |
| Date: |
| capacity Bidder with authority to submit a binding bid for the provision of Click here to enter: |
| Company Name: |
| Area Code: |
| City State Zip Code: |
| Phone Number: |
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