B08-SOL_W912PF20Q002_ ATT 01_AntiMafia.pdf

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Recurring Maintenance and cleaning of grease traps, Lift Pumping Stations, Rain and Sediment Tanks, Emergency Lift Stations, Water Treatment Systems, Water Depuration Systems at the United States Army Garrison (USAG) Italy, Vicenza.
Solicitation number
W912PF20Q0025
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This document contains an attachment to a solicitation for recurring maintenance and cleaning services at United States Army facilities in Italy. The solicitation seeks proposals for cleaning grease traps, lift pumping stations, rain and sediment tanks, emergency lift stations, water treatment systems, and water depuration systems at the United States Army Garrison in Vicenza, Italy. The first attachment is an anti-mafia certification form requiring the bidder to attest that they are not subject to prohibitions or suspensions related to organized crime as defined in Italian law. The solicitation details the required recurring maintenance and cleaning services but does not provide pricing, response date, or award date information.

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W912PF20Q0025

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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