Attachment D Vendor Certification.pdf
PDF 17 KB Posted
- Attached to
- EKLC Teacher Desks RFP
- Solicitation number
- RFP GIS 210000002736 1
- 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 the Iran Economic Sanctions Act under Public Act 517 of 2012. The form serves as a prerequisite certification document that bidders must complete and have notarized before submitting proposals for services to the school district. All prospective contractors, vendors, and respondents are required to certify that they are not Iran-linked businesses as defined under Michigan law, and submission of this sworn and notarized certification is mandatory for bid acceptance.
Bidders who submit false certifications face significant 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 the bidder's name, address, contact information, and authorized representative details, along with the signature and date of the person authorized to bind the contractor or vendor. The certification must be acknowledged before a notary public, who must provide their signature, date, and commission expiration information, confirming the notarization took place in the specified county.
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Other files
| File | Type | Posted |
|---|---|---|
| Instruction to Bidders.pdf | ||
| Attachment A Project Description.pdf | ||
| Attachment C Familial Statement.pdf | ||
| Attachment B Part II 10.12.2021.xlsx | XLSX spreadsheet | |
| Attachment B Bid Form Part I.pdf | ||
| Attachment E School Safety Affidavit.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
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Attachment D Vendor Certification_.pdf
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