Attachment D Vendor Certification.pdf
PDF 14 KB Posted
- Attached to
- EKLC Furniture
- Solicitation number
- RFP GIS 190000001982 2
- Issued by
- Genesee County, Michigan
About this file
This is a vendor certification form required by the Genesee Intermediate School District in Flint, Michigan, for all bidders submitting proposals for services to the district. The form serves as a sworn certification of compliance with Michigan's Iran Economic Sanctions Act (MCL 129.311, et seq.), requiring bidders to attest that they are not Iran-linked businesses as defined by state law. All bids submitted without this notarized certification will be rejected, making completion mandatory for participation in any solicitation issued by the district.
Bidders must provide their company name and address, contact information, and the name and title of the person authorized to bind the contractor, along with their signature and date. The certification must be acknowledged and notarized by a public notary in the appropriate county. Bidders should be aware that submission of false certification may result in contract termination, ineligibility to bid for three years, civil penalties of $250,000 or twice the bid amount (whichever is greater), and responsibility for investigation and legal costs. The form requires completion of placeholder fields indicating the specific services being bid and the bidder's capacity (individual or representative).
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Other files
| File | Type | Posted |
|---|---|---|
| Attach C Familial Statement.pdf | ||
| Addendum 1 no bid bond.pdf | ||
| Attachment A Project Description.pdf | ||
| Instructions to Bidders.pdf | ||
| Attachment B.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 .