B08-SOL_W912PF20Q0057_ ATT 01_AntiMafia.pdf

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Attached to
MILITARY FAMILY HOUSING MAINTENANCE AND REPAIR SERVICES, VICENZA, ITALY
Solicitation number
W912PF20Q0057
Issued by

About this file

This document is an anti-mafia certification form required as an attachment for solicitation number W912PF20Q0057 from the Department of the Army Materiel Command Army Contracting Command. The form requires the contractor to declare that they are not subject to prohibitions or suspensions related to organized crime as defined in Italian law, and acknowledges that any false statements could result in penalties or loss of eligibility for benefits. The certification collects personal information from the contractor's representative but states it will only be used for the purpose of the bid and will be handled according to Italian data protection laws.

The related solicitation is for military family housing maintenance and repair services at Vicenza, Italy. No further details are provided in the attachments beyond requiring this anti-mafia certification form to be completed and submitted by contractors responding to the solicitation.

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W912PF20Q0057

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)

File details come from the government source that posted it. Updated .