DisclosureofProhibitedActivitesinRussiaBelarus_(2).pdf
PDF 170 KB Posted
- Attached to
- Third Party Elevator Inspections
- Solicitation number
- 2026-23
- 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 New Jersey State law (N.J.S.A. 52:32-60.1, et seq.) for vendors seeking to enter into or renew contracts with State agencies. The form applies to the City of Newark's RFP 2026-23 for Third Party Elevator Inspections. Vendors must certify their status regarding the Office of Foreign Assets Control (OFAC) Specially Designated Nationals and Blocked Persons list, with three certification options available: confirming non-identification on the OFAC list due to Russia/Belarus-related activity; disclosing identification on the list due to Russia/Belarus activity; or disclosing identification on the list while claiming activity consistent with federal law, regulation, license, or exemption. RFP responses for the elevator inspections contract must be submitted electronically through the City's e-Procurement Portal by 2:00 pm on Tuesday, November 24, 2026, with public opening and reading aloud immediately following the deadline.
The certification form requires vendors to provide detailed company information including Federal Employer Identification Number (FEIN), business address, phone, fax, and email contact details, along with signature and date from an authorized representative. If a vendor selects certification option C, indicating OFAC list identification with claimed federal compliance, a detailed written explanation of the activity's consistency with federal law must be attached. Failure to complete accurate certification may result in sanctions, contract default declaration, debarment or suspension, compliance demands, or damage recovery actions by the Department of the Treasury. The form emphasizes that vendors must review the OFAC list directly at https://sanctionssearch.ofac.treas.gov/ prior to certification submission and that electronic submissions must be completed well in advance of the deadline, as the system will reject any proposals submitted after the deadline has passed.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Third_Party_Elevator_Inspections.pdf | ||
| Letter_of_Qualification_and_Letter_of_Intent.docx | DOCX document | |
| Disclosure_of_Iran_Investments.docx | DOCX document | |
| Federal_Debarment_Form.pdf | ||
| Vendor_Submission_Forms_(2025).pdf | ||
| W-9_(March2024).pdf |
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 .