Attachment D Vendor Certification_.pdf
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- Attached to
- 4-Post Alignment RFP
- Solicitation number
- RFP GIS 200000000070 3
- Issued by
- Genesee County, Michigan
About this file
This is a vendor certification form issued by the Genesee Intermediate School District located in Flint, Michigan, requiring compliance with the Iran Economic Sanctions Act under Michigan Public Act 517 of 2012. The form must be completed and notarized by any bidder seeking to provide services to the school district. The certification requires the bidder to confirm that their organization is not an Iran-linked business as defined under MCL 129.311, et seq., and to provide authorized signature, company information including name, address, and contact details, along with the name and title of the person authorized to bind the contractor.
Failure to submit a properly sworn and notarized certification will result in bid rejection. Vendors submitting false certifications face serious penalties including contract termination, ineligibility to bid for three years, and civil penalties of $250,000 or twice the bid amount, whichever is greater, plus investigation and legal costs. The form requires acknowledgment before a notary public with documentation of the county, date, state, and notary commission expiration date.
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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 .