Attachment D Vendor Certification.pdf
PDF 28 KB Posted
- Attached to
- Mechatronics Equipment RFP
- Solicitation number
- RFP GIS 210000002623 1
- Issued by
- Genesee County, Michigan
About this file
This is a vendor certification form for the Genesee Intermediate School District, located at 2413 West Maple Avenue, Flint, Michigan. The document serves as a certification requirement under Public Act 517 of 2012, specifically the Iran Economic Sanctions Act (MCL 129.311, et seq.). Bidders must complete and submit this notarized certification to confirm they are not Iran-linked businesses as defined by the Act. The form requires the bidder to provide company name and address, contact information, and the name and title of the person authorized to bind the contractor. All bids submitted without this sworn and notarized certification will not be accepted.
The certification carries significant penalties for false submission, 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 form must be notarized before a Notary Public, who is required to acknowledge the certification and provide their signature, commission expiration date, and the county in which they are acting. This certification is a mandatory compliance document that demonstrates the bidder's awareness of and adherence to Michigan's Iran Economic Sanctions Act before the school district will consider any bid submission.
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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
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Attachment D Vendor Certification_.pdf
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