DisclosureofProhibitedActivitesinRussiaBelarus_(2).pdf
PDF 170 KB Posted
- Attached to
- Fire Equipment and Installation
- Solicitation number
- 2026-001
- 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 pursuant to N.J.S.A. 52:32-60.1 for any person or entity seeking to enter into or renew a contract with a State agency. The certification requires vendors to verify their status against the Office of Foreign Assets Control (OFAC) Specially Designated Nationals and Blocked Persons list and confirm that they are not identified on this list due to activity related to Russia and/or Belarus. The form provides three certification options: vendors may certify they are not identified on the OFAC list; indicate they are unable to certify due to OFAC listing related to Russia and/or Belarus; or certify they are on the OFAC list but engaged in activity related to Russia and/or Belarus consistent with federal law, regulation, license, or exemption. Vendors must provide their authorized representative's signature and date, along with complete company information including legal name, Federal Employer Identification Number (FEIN), address, phone number, fax number, and email address.
The form defines "Vendor" broadly to encompass natural persons, corporations, partnerships, limited liability entities, governmental entities, and any parent, successor, subsidiary, or entity under common ownership or control with these entities. The Department of the Treasury enforces compliance with this certification requirement and may impose sanctions, seek damages, declare parties in default, or pursue debarment or suspension against any vendor making false certifications. No specific pricing, set-asides, funding amounts, or contract terms are detailed within this certification document, as it functions solely as a compliance verification requirement applicable to all New Jersey State agency contracting.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Fire_Equipment_and_Installation.pdf | ||
| Fire_Equipment_and_Installation.pdf | ||
| DisclosureofProhibitedActivitesinRussiaBelarus_(2).pdf | ||
| Vendor_Submission_Forms_(2025).pdf | ||
| Federal_Debarment_Form.pdf | ||
| Vendor_Submission_Forms_(2025).pdf | ||
| W-9_(March2024)_(5).pdf | ||
| Disclosure_of_Iran_Investments.docx | DOCX document | |
| W-9_(March2024)_(5).pdf | ||
| Federal_Debarment_Form.pdf | ||
| Disclosure_of_Iran_Investments.docx | DOCX document |
Show all 11
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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: |
File details come from the government source that posted it. Updated .