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 completion of a certification regarding involvement with entities on the Office of Foreign Assets Control (OFAC) Specially Designated Nationals and Blocked Persons list related to Russia and/or Belarus.

The form provides three certification options: (A) the vendor is not identified on the OFAC list, (B) the vendor is identified on the list and unable to certify, or (C) the vendor is identified but engaged in activities consistent with federal law, regulations, licenses, or exemptions. The document requires vendors to provide detailed contact information, including vendor name, address, FEIN, phone number, and authorized representative details. The form is part of a compliance process that may involve potential actions such as imposing sanctions, recovering damages, or seeking debarment if the certification is found to be inaccurate.