CTR057413_Uyghurs_Form.pdf
PDF 424 KB Posted
- Attached to
- Master Agreement AZ|CTR057413
- Contract number
- CTR057413
- Issued by
- Arizona
About this file
This document is a State of Arizona State Procurement Office form titled "Forced Labor of Ethnic Uyghurs Ban" with reference number CTR057413. The form is specifically for Aquaculture FDA-Approved Products and is associated with the Arizona State Procurement Office located in Phoenix, Arizona. The document requires written certification from companies entering into contracts with public entities to confirm they do not use forced labor of ethnic Uyghurs in the People's Republic of China.
The specific company completing this form is Western Chemical dba Syndel USA, located at 1441 W Smith R in Ferndale, WA 98248. The representative, Jason Montgomery (Sales Manager), has checked the box indicating the company does not use and agrees not to use forced labor of ethnic Uyghurs, goods or services produced by such labor, or contractors/subcontractors/suppliers involved in such practices during the contract term. The form is part of compliance with Arizona Revised Statutes § 35-394, which applies to for-profit companies with ten or more full-time employees seeking to contract with public entities in Arizona.
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Forced Labor of Ethnic Uyghurs Ban
Reference#
PAGE
Description:
OF
Forced Labor o_!Ethni Uyghurs B - - - - - - - - - - - - -
State of Arizona State Procurement Office 100 N 15th Avenue, Ste 350
Phoenix, AZ. 85007
PI ease note that if any of the following apply to the Contractor, then the Offeror shall select the "Exempt Contractor" option below:
• Contractor is a sole proprietorship;
• Contractor has fewer than ten (10) employees; OR
• Contractor is a non-profit organization.
Pursuant to A.R.S. § 35-394, written certification is required to show that the company entering into a contract with a public entity does not use the forced labor, or any goods or services produced by the forced labor, of ethnic Uyghurs in the People's Republic of China.
Under A.R.S. § 35-394:
1. "Company" means an organization, association, corporation, partnership, joint venture, limited partnership, limited liability partnership, limited liability company or other entity or business association, including a wholly owned subsidiary, majority-owned subsidiary, parent company or affiliate, that engages in for-profit activity and that has ten or more full-time employees.
2. "Public entity" means this State, a political subdivision of this State or an agency, board, commission or department of this State or a political subdivision of this State.
In compliance with A.R.S. §§ 35-394 et seq., all offerors must select one of the following:
XX The Company submitting this Offer does not use, and agrees not to use during the term of the contract, any of the following:
• Forced labor of ethnic Uyghurs in the People's Republic of China;
• Any goods or services produced by the forced labor of ethnic Uyghurs in the People's Republic of
China; or
• Any Contractors, Subcontractors, or suppliers that use the forced labor or any goods or services produced by the forced labor of ethnic Uyghurs in the People's Republic of China.
□ The Company submitting this Offer does participate in use of Forced Uyghurs Labor as described in A.R.S. §
35-394.
□ Exempt Contractor
Indicate which of the following statements applies to the Contractor (may be more than one):
□ Contractor is a sole proprietorship;
□ Contractor has fewer than ten ( 10) employees; and/or
□ Contractor is a non-profit organization.
Company Name
Address Printed name and title
City, State, ZIP Contact email address Contact phone number
SPO Form 205 - Forced Labor of Ethnic Uyghurs Ban I Revision No. 1 I Revised 09-22
CTR057413
AQUACULTURE FDA-APPROVED PRODUCTS
File details come from the government source that posted it. Updated .