DisclosureofProhibitedActivitesinRussiaBelarus_(2).pdf
PDF 170 KB Posted
- Attached to
- Work Gloves
- Solicitation number
- 2025-99
- Issued by
- Essex County, New Jersey
About this file
This is a Certification of Noninvolvement in Prohibited Activities in Russia or Belarus form required by the State of New Jersey for the City of Newark's Invitation to Bid (ITB) #2025-99 for work gloves. Pursuant to N.J.S.A. 52:32-60.1 (L. 2022, c. 3), all vendors seeking to enter into or renew contracts with state agencies must complete this certification. The procurement solicits bids for approximately 50 different types of work gloves, including chemical protective, leather, neoprene, and disposable variants for various municipal applications such as welding, industrial work, food handling, and medical examinations. Electronic bids must be submitted through the City's e-Procurement Portal by November 25, 2025, at 10:15 am, with vendor questions due by November 19, 2025. The contract is structured for a two-year term with separate pricing tables for Year 1 and Year 2, with each line item representing a single pair or box of gloves. The City reserves the right to award contracts to multiple vendors based on line item commodities and adjust contract quantities as needed.
Vendors must certify their status on the Office of Foreign Assets Control (OFAC) Specially Designated Nationals and Blocked Persons list by selecting one of three options: (A) confirming non-identification on the list related to Russia and Belarus activity, (B) disclosing identification on the list due to Russia and Belarus activity, or (C) disclosing identification on the list while asserting that activity is consistent with federal law, regulation, license, or exemption. Bidders are required to provide all-inclusive unit pricing covering labor, materials, transportation, and handling. The procurement includes mandatory compliance requirements including affirmative action regulations, anti-discrimination provisions, Americans with Disabilities Act compliance, and submission of multiple documentation forms such as a Hold Harmless Agreement, Non-Collusion Affidavit, Iran Investment Disclosure, and Federal Non-Debarment Certification. Vendors must provide proof of business registration and appropriate insurance. The Department of the Treasury may impose sanctions, seek compliance, recover damages, declare parties in default, or pursue debarment or suspension for false certifications.
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Other files
| File | Type | Posted |
|---|---|---|
| Work_Gloves.pdf | ||
| Work_Gloves.pdf | ||
| DisclosureofProhibitedActivitesinRussiaBelarus_(2).pdf | ||
| Federal_Debarment_Form.pdf | ||
| W-9_(March2024)_(5).pdf | ||
| Disclosure_of_Iran_Investments.docx | DOCX document | |
| Vendor_Submission_Forms_(2025).pdf | ||
| Disclosure_of_Iran_Investments.docx | DOCX document | |
| Vendor_Submission_Forms_(2025).pdf | ||
| W-9_(March2024)_(5).pdf | ||
| Federal_Debarment_Form.pdf |
Show all 11
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Text version
CERTIFICATION OF NON‐INVOLVEMENT IN
PROHIBITED ACTIVITIES IN RUSSIA OR BELARUS
NJ Rev. 1.22.2024
Pursuant to N.J.S.A. 52:32-60.1, et seq. (L. 2022, c. 3) any person or entity (hereinafter “Vendori”) that seeks to enter into or renew a contract with a State agency for the provision of goods or services, or the purchase of bonds or other obligations, must complete the certification below indicating whether or not the Vendor is identified on the Office of Foreign Assets Control (OFAC) Specially Designated Nationals and Blocked Persons list, available here:
https://sanctionssearch.ofac.treas.gov/. If the Department of the Treasury finds that a Vendor has made a certification in violation of the law, it shall take any action as may be appropriate and provided by law, rule or contract, including but not limited to, imposing sanctions, seeking compliance, recovering damages, declaring the party in default and seeking debarment or suspension of the party.
I, the undersigned, certify that I have read the definition of “Vendor” below, and have reviewed the Office of Foreign Assets Control (OFAC) Specially Designated Nationals and Blocked Persons list, and having done so certify:
(Check the Appropriate Box)
A. That the Vendor is not identified on the OFAC Specially Designated Nationals and Blocked Persons list on account of activity related to Russia and/or Belarus.
OR
B. That I am unable to certify as to “A” above, because the Vendor is identified on the OFAC Specially Designated Nationals and Blocked Persons list on account of activity related to Russia and/or Belarus.
OR
C.
That I am unable to certify as to “A” above, because the Vendor is identified on the OFAC Specially Designated Nationals and Blocked Persons list. However, the Vendor is engaged in activity related to Russia and/or Belarus consistent with federal law, regulation, license or exemption. A detailed description of how the Vendor’s activity related to Russia and/or Belarus is consistent with federal law is set forth below.
(Attach Additional Sheets If Necessary.)
Signature of Vendor’s Authorized Representative Date
Print Name and Title of Vendor’s Authorized Representative Vendor’s FEIN
Vendor’s Name Vendor’s Phone Number
Vendor’s Address (Street Address) Vendor’s Fax Number
Vendor’s Address (City/State/Zip Code) Vendor’s Email Address i Vendor means: (1) A natural person, corporation, company, limited partnership, limited liability partnership, limited liability company, business association, sole proprietorship, joint venture, partnership, society, trust, or any other nongovernmental entity, organization, or group; (2) Any governmental entity or instrumentality of a government, including a multilateral development institution, as defined in Section 1701(c)(3) of the International Financial Institutions Act, 22 U.S.C. 262r(c)(3); or (3) Any parent, successor, subunit, direct or indirect subsidiary, or any entity under common ownership or control with, any entity described in paragraph (1) or (2).
https://pub.njleg.state.nj.us/Bills/2022/PL22/3_.PDF https://sanctionssearch.ofac.treas.gov/ https://sanctionssearch.ofac.treas.gov/ https://sanctionssearch.ofac.treas.gov/ https://sanctionssearch.ofac.treas.gov/ https://sanctionssearch.ofac.treas.gov/ https://sanctionssearch.ofac.treas.gov/
| Vendors Phone Number: |
| Vendors Fax Number: |
| Vendors Email Address: |
| Group1: Off |
| the Vendors activity related to Russia andor Belarus is consistent with federal law is set forth below 1: |
| the Vendors activity related to Russia andor Belarus is consistent with federal law is set forth below 2: |
| the Vendors activity related to Russia andor Belarus is consistent with federal law is set forth below 3: |
| the Vendors activity related to Russia andor Belarus is consistent with federal law is set forth below 4: |
| the Vendor’s activity related to Russia and/or Belarus is consistent with federal law is set forth below 5: |
| the Vendor’s activity related to Russia and/or Belarus is consistent with federal law is set forth below 6: |
| Signature of Vendor's Authorized Representative: |
| Print Name and Title of Vendors Authorized Representative: |
| Vendors Name: |
| Vendors Address Street Address: |
| Vendors Address CityStateZip Code: |
| Date: |
| Vendors FEIN: |
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