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 or renew a contract with a state agency, requiring 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 non-involvement, or (C) the vendor is identified but engaged in activities consistent with federal law, regulation, license, or exemption. The document requires detailed vendor information including contact details, signature of an authorized representative, and includes a comprehensive definition of "vendor" that encompasses various business entity types. The form is dated NJ Rev. 1.22.2024 and is associated with a potential contract for Batteries Storage, Automotive for the City of Newark, New Jersey.