Certificate_of_Non-Involvement_in_Prohibited_Activities_In_Russia_or_Belarus.pdf

This document is a Certification of Non-Involvement in Prohibited Activities in Russia or Belarus form for Contract #07-WS2025, issued by the State of New Jersey. The form is a mandatory certification required for vendors seeking to enter into a contract with a state agency, specifically related to the procurement of goods or services. Vendors must complete this document to indicate whether they are identified on the Office of Foreign Assets Control (OFAC) Specially Designated Nationals and Blocked Persons list in connection with activities in Russia and/or Belarus.

The form provides three certification options: (A) the vendor is not identified on the OFAC list related to Russia and Belarus, (B) the vendor is identified on the list and unable to certify compliance, or (C) the vendor is identified but engaged in activities consistent with federal law, regulations, licenses, or exemptions. The document requires detailed vendor information including contact details, signature of an authorized representative, and includes a broad definition of "vendor" that encompasses various business entities such as corporations, partnerships, and joint ventures.