Attachment1_Antimafia.pdf

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Armed Security Guards Services at USAG - Italy
Solicitation number
W912PF21R0002
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This document is an affidavit regarding antimafia communications that must be submitted with proposals for an armed security guard services contract. The contract is solicited by the Department of the Army Materiel Command Army Contracting Command on behalf of the USAG Italy. Proposers must declare in the affidavit that they are not subject to prohibitions or suspensions related to organized crime under Italian law. The affidavit requires the proposer's personal information and signature and states that submitted personal data will be processed according to data protection laws.

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W912PF21R0002

ATTACHMENT 1

Autocertificazione della comunicazione antimafia.

Dichiarazione sostitutiva di certificazione (D.P.R. n. 445 del 28.12.2000)

Il/la sottoscritto/a (nome e cognome) C.F._ nato/a Prov. il residente a Prov. in via/piazza

n. , in qualità di (carica ricoperta) dell’impresa

(indicare la denominazione)

C.F.

avente la sede in n.

Prov. di Via consapevole delle sanzioni penali in caso di dichiarazioni false e della conseguente decadenza dai benefici eventualmente conseguiti (ai sensi degli artt. 75 e 76 D.P.R. 445/2000) sotto la propria responsabilità

DICHIARA

che nei propri confronti non sussistono le cause di divieto, di decadenza o di sospensione di cui all’art. 67 del D.lgs. n. 159 del 06/09/2011.

Il/la sottoscritto/a dichiara inoltre di essere informato/a, ai sensi del D.Lgs. n. 196/2003 (codice in materia di protezione di dati personali) che i dati personali raccolti saranno trattati, anche con strumenti informatici, esclusivamente nell’ambito del procedimento per il quale la presente dichiarazione viene resa.

data firma leggibile del dichiarante (2)

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