B08-SOL_W912PF26QA011_Attachment7_SelfCertificationforAntimafiaCommunication.pdf

This is a declaration form required for federal contract opportunity W912PF26QA011. The document is an Italian anti-mafia certification declaration (Autocertificazione della comunicazione antimafia) that serves as a substitute certification per D.P.R. n. 445 del 28.12.2000.

The form requires the signatory to declare their full name, tax identification number (C.F.), birthplace, province, and current residence address. The declarant must identify their role within the company and provide the company's name, tax identification number, and registered office address including province and street location. The signatory attests under penalty of perjury that they are aware of criminal sanctions for false declarations and potential loss of benefits, consistent with articles 75 and 76 of D.P.R. 445/2000. The declarant must confirm that they are not subject to any prohibitions, disqualifications, or suspensions as outlined in article 67 of Legislative Decree n. 159 of 06/09/2011. Additionally, the form includes a data protection statement notifying the declarant that personal data collected will be processed exclusively within the scope of the procurement procedure for which this declaration is submitted, in compliance with D.Lgs. n. 196/2003. The document requires a legible signature and date from the declarant.