Attachment D Vendor Certification.pdf
PDF 11 KB Posted
- Attached to
- Early On Furniture
- Solicitation number
- RFP GIS 180000000465 4
- Issued by
- Genesee County, Michigan
About this file
This is a vendor certification form required by the Genesee Intermediate School District located in Flint, Michigan, for compliance with Michigan's Public Act 517 of 2012 Iran Economic Sanctions Act. The certification must be completed and notarized by any bidder seeking to provide services to the school district. The form requires the bidder to provide company or individual name, address, contact number, and the name and title of the person authorized to execute binding agreements on behalf of the contractor or vendor. The bidder must certify under oath that they are not an Iran-linked business as defined by the Act and acknowledge full awareness that the school district will rely on these representations when evaluating bids.
Submission of this sworn and notarized certification is mandatory; bids lacking this document will not be accepted. Bidders are notified that submission of false certification may result in severe penalties including contract termination, ineligibility to bid for three years, and a civil penalty of $250,000 or twice the bid amount, whichever is greater, plus investigation and legal costs. The certification must be executed by an authorized representative and acknowledged before a notary public, with completion of notarization details including county, date, notary signature, and commission expiration date.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment A Project Description.pdf | ||
| Instructions to Bidders.pdf | ||
| Early On Furniture List.pdf | ||
| Attachment B Bid Form Part I.pdf | ||
| Attachment C Familial Statement.pdf |
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Text version
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 Click here to enter text of Click here to enter text, 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 sworn and notarized 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
Seal:
This instrument was acknowledged before me, a Notary Public, in and for ___________________________ County, _____________________ on this _________ day of ________________________, 20_________.
State
Notary Public Signature Date
My Commission Expires: _______________________
Acting in the County of: ________________________
Attachment D
File details come from the government source that posted it. Updated .