Attachment D Vendor Certification_.pdf
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- Attached to
- Crane & Heavy Equipment Operator Simulator
- Solicitation number
- RFP GIS 210000000111 3
- Issued by
- Genesee County, Michigan
About this file
This is a vendor certification document issued by Genesee Intermediate School District located in Flint, Michigan, in compliance with Public Act 517 of 2012, the Iran Economic Sanctions Act. The certification requires bidders to confirm they are not Iran-linked businesses as defined under MCL 129.311, et seq. The document serves as a mandatory requirement for bid submission and must be completed, sworn, and notarized before a Notary Public. All bids submitted without this sworn and notarized certification will be rejected from consideration.
The certification form requires bidders to provide company or individual name, address, contact number, and identify the person authorized to bind the contractor or vendor. Bidders must acknowledge understanding that submission of false certification may result in 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 notarization must include the county of acknowledgment, date of execution, and the notary's signature with commission expiration date and acting county.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment B Part I.pdf | ||
| Attach C Familial Statement_.pdf | ||
| Attachment B Part II Bid Form.pdf | ||
| Attachment B BID FORM Part III.xlsx | XLSX spreadsheet | |
| Acc Attachment A Project Description.pdf | ||
| Addendum No. 1.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 .