EXHIBIT D IRAN ECONOMIC SANCTIONS FORM.pdf
PDF 51 KB Posted
- Attached to
- IFB 25. 0030 AAPS Band and String Instruments
- Solicitation number
- 25.0030
- Issued by
- Washtenaw County, Michigan
About this file
This document is an Iran Economic Sanctions Certification form for Invitation for Bid (IFB) 25.0030 issued by Ann Arbor Public Schools (AAPS) in Michigan, specifically related to a procurement for band and string instruments. The certification requires potential contractors to affirm they are not an "Iran linked business" as defined by Michigan Public Act No. 517 of 2012, and pledge to remain non-compliant with Iranian economic sanctions throughout the potential contract period.
The form outlines significant penalties for false certification, including a civil penalty of up to $250,000 or double the contract value, investigation costs, and attorney fees. Additionally, any entity submitting a false certification would be barred from bidding on school district contracts for three years. The document provides a standard template for contractors to complete, requiring company name, authorized representative signature, printed name, title, and date of certification. This certification is a mandatory compliance requirement for participating in the Ann Arbor Public Schools band and string instruments procurement process.
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Other files
| File | Type | Posted |
|---|---|---|
| IFB 25.0030 Instruments _ Strings.pdf | ||
| Q&A Document 1.pdf | ||
| EXHIBIT B CONTRACTOR INFORMATION FORM.pdf | ||
| EXHIBIT E CERTIFICATION FORM.pdf | ||
| EXHIBIT A SPECIFICATIONS AND PRICING PROPOSAL.xlsx | XLSX spreadsheet | |
| EXHIBIT C FAMILIAL DISCLOSURE STATEMENT.pdf |
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Text version
IFB 25.0030 – AAPS Band and String Instruments
EXHIBIT D: IRAN ECONOMIC SANCTIONS
CERTIFICATION OF COMPLIANCE - IRAN ECONOMIC SANCTIONS ACT
Michigan Public Act No. 517 of 2012
The undersigned, the district or authorized officer of the below-named contractor (the Contractor”), pursuant to the compliance certification requirement provided in the Ann Arbor
Public Schools' (the “School District”) Invitation For Bid, hereby certifies, represents and warrants that the Contractor (including its officers, directors and employees) is not an “Iran linked business” within the meaning of the Iran Economic Sanctions Act, Michigan Public Act
No. 517 of 2012 (the “Act”), and that in the event Contractor is awarded a contract as a result of the aforementioned IFB, the Contractor will not become an “Iran linked business” at any time during the course of performing any services under the contract.
The Contractor further acknowledges that any person who is found to have submitted a false certification is responsible for a civil penalty of not more than $250,000.00 or 2 times the amount of the contract or proposed contract for which the false certification was made, whichever is greater, the cost of the School District’s investigation, and reasonable attorney fees, in addition to the fine. Moreover, any person who submitted a false certification shall be ineligible to bid on an Invitation For Bid for three (3) years from the date it is determined that the person has submitted the false certification.
Contractor:
Name of Company
Signature of Authorized Representative
Name of Authorized Representative
Title of Authorized Representative
Date
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