Attachment_I_Notarized_Scrutinized_Companies_Certification.pdf
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- Attached to
- Body Shop Repairs
- Solicitation number
- ITB 0029-24
- Issued by
- Lee County, Fort Lauderdale City, Florida
About this file
This document is a Notarized Affidavit for Scrutinized Companies Certification from the City of Fort Myers, Florida, related to a Fleet Auto Body Repair contract opportunity. The affidavit requires respondents to certify that they are not on any scrutinized companies lists related to Sudan, Iran, Cuba, or Syria, and have not engaged in a boycott of Israel. The certification is a mandatory requirement for companies seeking to submit a bid or proposal for the city's contract.
The affidavit includes legal provisions stating that falsification of the certification may result in contract termination, debarment from bidding for three years, potential civil penalties, and assessment of attorney's fees. The document must be signed and notarized, with the respondent affirming they are authorized to submit the certification on behalf of their company and that the company is prepared to perform if awarded the contract. The respondent also acknowledges an ongoing obligation to inform the public entity of any changes to the information provided in the certification.
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Text version
ATTACHMENT I
Notarized Affidavit
SCRUTINIZED COMPANIES CERTIFICATION
Respondents hereby certifies under penalties of perjury, as of the date of this Solicitation to provide goods and services to the City, that it has not been placed on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List as defined in Section 287.135, Fla. Stat., is not engaged in business operations in Cuba and Syria; and has not engaged in a boycott of Israel and has not been placed on the Scrutinized Companies that Boycott Israel List created after October 1, 2016 and during the term of any contract awarded under this Solicitation.
I further certify that I am duly authorized to submit this certification on behalf of the company as its agent and that the company is ready, willing, and able to perform if awarded a contract.
I understand that the submission of this form to the contracting officer for the public entity identified in Paragraph 1 above is for that public entity only and, that falsification of this certification may result in termination of the contract, debarment of the company from submitting an offer for a period of three (3) years from the date the certification is determined to be false, civil penalties, and the assessment of attorney’s fees and costs against the company. I also understand that I am required to inform the public entity prior to entering a contract of any change in the information contained in this form.
[Signature]
Notary Public
State of ___________________ County of _________________
Sworn to and subscribed before me this _______ day of ________________________, 20____, by ______________________________________________ who produced the following as identification _____________________________ (Type of identification) or is personally known to me. My Commission Expires
__________________________________________ [stamp or seal] [Signature of Notary Public]
[Typed or printed name]
File details come from the government source that posted it. Updated .