Attachment I - PUR-7801.Vendor-Certification-Form.docx
DOCX document 56 KB Posted
- Attached to
- RFP DMS-2526-098 Lawn Care Services
- Solicitation number
- RFP-16572
- Issued by
- Leon County, Florida
About this file
This is a Vendor Certification Form (PUR-7801) required by the State of Florida, Department of Management Services for the RFP DMS-2526-098 Lawn Care Services solicitation. The form establishes vendor compliance requirements across multiple regulatory and statutory domains, including certifications regarding boycotts of Israel, scrutinized companies lists, vendor suspension status, and prohibited vendor designations. Vendors must attest to their registration and use of the E-Verify system for newly hired employees, compliance with disclosure requirements, and adherence to anti-coercion and forced labor provisions. For contracts exceeding $1 million in value, vendors must confirm they are not on the Scrutinized Companies with Activities in Sudan or Iran Terrorism Sectors lists and do not maintain business operations in Cuba or Syria. Additionally, if the contract grants access to personal identifying information, vendors must complete Form PUR 1355 (Foreign Country of Concern Attestation Form). The form requires authorized vendor representatives to sign and date the certification under penalty of perjury.
The certification requirements are tiered based on contract characteristics and dollar thresholds, with certain provisions applying universally regardless of contract value while others are triggered by specific conditions such as commodity provision or personal data access. The form serves as a prerequisite for vendor participation in state procurement and establishes the vendor's acknowledgment of the statutory impacts to their ability to bid on future state solicitations should they be placed on various prohibited vendor lists maintained by the Department of Management Services. Vendors must complete and submit this form as part of their proposal package for the lawn care services contract covering multiple facilities across the Pensacola, Tallahassee, and Tampa regions.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment C - Price Sheet.xlsx | XLSX spreadsheet | |
| RFP DMS-2526-098 - Lawn Care Tallahassee & Tampa.pdf | ||
| Attachment F - Technical Response.pdf | ||
| Attachment E - Responsiveness Technical Questionnaire.xlsx | XLSX spreadsheet | |
| DMS-2526-098 Q&A.pdf | ||
| Attachment D - Performance Standards.pdf | ||
| Addendum No. 2 (2).pdf | ||
| ATTACHMENT J - PUR 2024.docx | DOCX document | |
| RFP DMS-2526-098 Addendum No. 1.pdf | ||
| Attachment H - Equipment List.xlsx | XLSX spreadsheet | |
| Attachment K - Draft Contract.pdf | ||
| Attachment G - Facility & Equipment Checklist.pdf | ||
| Attachment B - Monthly Summary Report.xlsx | XLSX spreadsheet | |
| Attachment A - Statement of Work - Lawn Care 2526-098.pdf |
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Text version
ATTACHMENT I
Vendor Certification Form
I hereby certify the following on behalf of the vendor identified below:
| Customer Indicator (Required, N/A, Determined by Vendor) |
| Vendor Indicator (Certified, N/A) |
| Certification |
| Required | |
| Choose an item. | Regardless of the dollar value of the goods or services provided, in accordance with the requirements of section 287.135(5), F.S., the vendor is not participating in a boycott of Israel and is not on the State Board of Administration’s “Quarterly List of Scrutinized Companies that Boycott Israel,” available at https://www.sbafla.com/governance/global-governance-mandates/ |
| Determined by Vendor | |
| Choose an item. | If the goods or services to be provided are $1 million or more, in accordance with the requirements of section 287.135, F.S., the vendor is not on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Terrorism Sectors List (collectively, “Scrutinized List of Prohibited Companies”); does not have business operations in Cuba or Syria; and is not on the State Board of Administration’s “Scrutinized List of Prohibited Companies” available under the quarterly reports section at https://www.sbafla.com/reporting/ |
| Required | |
| Choose an item. | The vendor is not on the Suspended Vendor List; it and its suppliers, subcontractors, or consultants to be utilized under the contract are not on the Convicted Vendor, Discriminatory Vendor, or Antitrust Violator Vendor Lists; and there is no pending or threatened action, proceeding, or investigation, or any other legal or financial condition, that would in any way prohibit, restrain, or diminish the vendor’s ability to satisfy the contract obligations. |
The vendor is hereby informed of the provisions of sections 287.133(2)(a), 287.134(2)(a), and 287.137(2)(a), F.S., that identify the impacts to the vendor's ability or its affiliates’ ability to respond to the competitive solicitations of a public entity; to be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with a public entity; or to transact business with a public entity if it, or its affiliates, are placed on the Convicted Vendor, Discriminatory Vendor, or Antitrust Violator Vendor Lists of the Department of Management Services. The vendor is hereby further informed of the provisions of section 287.1351, F.S., that identify the impacts to the vendor’s ability to enter into or renew a contract with an agency, as defined in section 287.012, F.S., if it is placed on the Suspended Vendor List of the Department of Management Services.
| N/A | |
| Choose an item. | If the contract grants the vendor access to an individual’s personal identifying information, the vendor is not prohibited from entering into the contract pursuant to section 287.138, F.S., and has completed the Form PUR 1355, “Foreign Country of Concern Attestation Form,” available at http://www.flrules.org/Gateway/reference.asp?No=Ref-15843, and attached it hereto. |
| Determined by Vendor | |
| Choose an item. | If the vendor is a common carrier, as defined in section 908.111, F.S., or a contracted carrier, it is not prohibited from entering into the contract pursuant to section 908.111, F.S., and has completed the Form PUR 1808, “Common Carrier or Contracted Carrier Attestation Form,” available at http://www.flrules.org/Gateway/reference.asp?No=Ref-14614, and attached it hereto. |
| Required | |
| Choose an item. | The vendor is registered with, and uses, the E-Verify system for all newly hired employees in accordance with section 448.095, F.S.; and has not, within the last year, had a contract terminated under section 448.095(5)(c), F.S., by a public employer, contractor, or subcontractor, as defined by section 448.095(1), F.S. |
| Required | |
| Choose an item. | The vendor is in compliance with all applicable disclosure requirements set forth in section 286.101, F.S., and has not been deemed ineligible for a grant or contract funded by a state agency pursuant to section 286.101(7), F.S. |
| Required | |
| Choose an item. | If the contract is between a nongovernmental entity and a governmental entity, in accordance with section 787.06, F.S., the vendor has completed an affidavit signed by an officer or a representative of the vendor under penalty of perjury attesting that the vendor does not use coercion for labor or services as defined in section 787.06, F.S. |
| Required | |
| Choose an item. | If the Contract is for the provision of commodities, in accordance with section 287.1346, F.S., the vendor, and any entity under the control of vendor, has not been placed on the Forced Vendor List within the past 365 days or, if placed on the Forced Vendor List, has been removed pursuant to section 287.1346(5)(d), F.S. |
If the Contract is for the provision of commodities, the Contractor will submit, prior to entering into or renewing the Contract, a written certification from senior management, as defined in section 287.1346(1)(c), F.S., which certifies to the best of their knowledge the commodities being offered pursuant to this solicitation have not been produced, in whole or in part, by forced labor.
The vendor is hereby informed of the provisions of section 287.1346, F.S., that identify the impacts to a vendor’s ability to respond to the competitive solicitations of a state agency; to be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with a state agency; or to transact business for the provision of commodities with a state agency if it, or entities under the control of the vendor, is placed on the forced labor list in accordance with section 287.1346, F.S.
By signing below, I certify that I am authorized to complete and submit this Vendor Certification Form on behalf of the vendor.
Vendor Information Signatory
Company Name Signature Date
FEIN Typed or Printed Name
Title Form PUR 7801 (07/2024) Rule 60A-1.002, F.A.C.
File details come from the government source that posted it. Updated .