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 designed for vendors seeking to enter into a contract with a state agency, requiring them to disclose whether they are identified on the Office of Foreign Assets Control (OFAC) Specially Designated Nationals and Blocked Persons list in relation to activities in Russia 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 but cannot certify compliance, or (C) the vendor is identified but engaged in activities consistent with federal law, regulations, licenses, or exemptions. The document requires vendors to complete vendor contact information, including name, address, FEIN, phone number, and includes a comprehensive definition of "vendor" that encompasses various business entity types. The form is dated NJ Rev. 1.22.2024 and appears to be part of a broader procurement process for the City of Newark, New Jersey.