Attachment J.pdf
PDF 236 KB Posted
- Attached to
- LAS/PBS Data Application Migration
- Solicitation number
- RFP-05004
- Issued by
- Leon County, Florida
About this file
This document is a vendor certification form related to a Request for Proposal (RFP) issued by the Executive Office of the Governor (EOG) of the State of Florida for a data application migration project for the Legislative Appropriations System/Planning and Budgeting Subsystem (LAS/PBS). The RFP seeks competitive sealed responses from qualified vendors, and the solicitation will be administered through the Florida Vendor Information Portal. The document outlines critical dates and actions related to the RFP, including addenda postings, timeline revisions, and RFP revisions. The project scope involves the migration of the LAS/PBS data application, and the solicitation covers the State of Florida as well as the local jurisdictions of Leon County and the City of Tallahassee.
The vendor certification form requires the respondent to certify that the company is not listed on the Scrutinized Companies with Activities in Sudan List, the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or the Scrutinized Companies that Boycott Israel List, and that the company is not engaged in a boycott of Israel. The form also includes instructions for submitting the response and contact information for the vendor.
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Text version
Florida Statutes:
287.135 VENDOR CERTIFICATION REGARDING
SCRUTINIZED COMPANIES LISTS
Respondent Vendor Name:
Vendor FEIN:
Vendor’s Authorized Representative Name and Title:
Address:
City: State: Zip:
Phone Number:
Email Address:
Section 287.135, Florida Statutes prohibits a company from bidding on, submitting a proposal for, or entering into or renewing a contract for goods or services of any amount if, at the time of contracting or renewal, the company is on the Scrutinized Companies that Boycott Israel List, created pursuant to Section 215.4725, Florida Statutes, or is engaged in a boycott of Israel. Section 287.135, Florida Statutes, also prohibits a company from bidding on, submitting a proposal for, or entering into or renewing a contract for goods or services of $1,000,000 or more, that are on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector Lists which were created pursuant to s. 215.473, Florida Statutes.
As the person authorized to sign on behalf of Respondent, I hereby certify that the company identified above in the section entitled “Respondent Vendor Name” is not listed on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or the Scrutinized Companies that Boycott Israel List. I further certify that the company is not engaged in a boycott of Israel. I understand that pursuant to section 287.135, Florida Statutes, the submission of a false certification may subject company to civil penalties, attorney’s fees, and/or costs.
Certified By:
who is authorized to sign on behalf of the above referenced company.
Authorized Signature Print Name and Title:
Date:
EOG-RFP-23-02
Attachment J - Vendor Certification Form
| REQUEST FOR PROPOSAL |
| PLEASE COMPLETE AND RETURN THIS FORM ASAP |
| E-Mail Address: _________________________________________________ |
| Vendor ID Number: |
| I N T R O D U C T I O N S E C T I O N |
| Provided below is a list of critical dates and actions. These dates are subject to change. Notices of changes (Addenda) will be posted on the Florida Vendor Information Portal at https://vendor.myfloridamarketplace.com/(click on “Search Advertisemen... |
| S P E C I A L C O N D I T I O N S |
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