B08-Attachment 14 Self Certification for Antimafia Communication.pdf

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Attached to
Maintenance and Repair of Electrical Distribution Systems - Darby Military Community (DMC)
Solicitation number
W912PF25QA065
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Written by GovTribe AI ·

This document is a Self-certification for Antimafia communication form for Solicitation W912PF25QA065, which is a standard Italian legal declaration form used in federal contracting. The form requires a company representative to self-certify that they do not have any disqualifying legal impediments related to anti-mafia regulations, specifically referencing Article 67 of Legislative Decree No. 159 from September 6, 2011. The form also includes a data protection declaration acknowledging that personal information collected will be processed exclusively for the related administrative procedure, in compliance with Italian data protection laws.

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B08-Attachment 13 Company Experience Questionnaire_rev.pdf PDF
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B08-Attachment 13 Company Experience Questionnaire.pdf PDF
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Attachment 14

Combined Synopsis Solicitation W912PF25QA065

Self-certification for Antimafia communication

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 _________________________ Prov. di __________ Via ___________________________ n. ______ 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 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.

DICHIARA

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.

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