Attachment D Vendor Certification.pdf
PDF 20 KB Posted
- Attached to
- GCI Phase II Furniture Bid
- Solicitation number
- RFP GIS 180000003226 1
- Issued by
- Genesee County, Michigan
About this file
This is a vendor certification document issued by the Genesee Intermediate School District located in Flint, Michigan, pursuant to Public Act 517 of 2012, the Iran Economic Sanctions Act. The document serves as a certification form that prospective bidders must complete and submit as a sworn and notarized statement when responding to contract opportunities with the school district. The certification requires the bidder or authorized representative to confirm that the bidding entity is not an Iran-linked business as defined under Michigan law (MCL 129.311, et seq.). The form includes fields for the contractor or vendor name, address, contact number, and the authorized representative's signature, title, and date. Notarization is mandatory, requiring a notary public's acknowledgment, signature, and commission expiration date.
Submission of this completed and notarized certification is a mandatory requirement for bid acceptance; any bids lacking this certification will be rejected. Bidders should be aware that submission of a false certification carries significant penalties, including contract termination, a three-year ineligibility to bid on future school district contracts, a civil penalty of $250,000 or twice the bid amount (whichever is greater), and liability for related investigation and legal costs. The school district reserves the right to rely on the bidder's representations when evaluating bids and determining contract awards.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment A Project Description.pdf | ||
| GCI Phase II - Attachment B.xlsx | XLSX spreadsheet | |
| Attachment C Familial Statement.pdf | ||
| Instruction to Bidders.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
| Name: |
| Address: |
| undefined: |
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| Print Name: |
| Title: |
| Date: |
| This instrument was acknowledged before me a Notary Public in and for 1: |
| This instrument was acknowledged before me a Notary Public in and for 2: |
| on this: |
| 20: |
| undefined_2: |
| Date_2: |
| My Commission Expires: |
| Acting in the County of: |
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