FORM 08-PUR 7801 VENDOR CERTIFICATION FORM.docx
DOCX document 113 KB Posted
- Attached to
- MyFloridaNet-3 ITN
- Solicitation number
- ITN-16760
- Issued by
- Florida
About this file
This is a Vendor Certification Form (Form 8-PUR 7801) issued by the Florida Department of Management Services for the MyFloridaNetwork-3 Invitation to Negotiate (ITN No. 26/27-025). The form serves as a standardized certification document that vendors must complete to participate in state procurement opportunities through the MyFloridaNetwork-3 system. The document does not specify particular products or services, response dates, due dates, site visits, bidder conferences, award dates, or contract terms, as it functions as a generic certification template for vendors rather than a specific solicitation notice.
The form requires vendors to certify compliance with multiple Florida statutes and state policies, including non-participation in boycotts of Israel, absence from scrutinized companies lists related to Sudan, Iran, Cuba, and Syria (for contracts valued at $1 million or more), and non-appearance on suspended, convicted, discriminatory, or antitrust violator vendor lists. Additional certifications address E-Verify compliance, disclosure requirements under Florida Statutes section 286.101, foreign country of concern attestations (if applicable), common carrier attestations (if applicable), and attestations regarding labor coercion practices. Vendors must provide FEIN, signatory name, signature, date, and title information. The form contains no pricing terms, set-asides, incumbent information, or funding details, as it is a certification instrument rather than a solicitation document with procurement specifications.
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Text version
4050 Esplanade Way Tallahassee, FL 32399-0950 850-488-2786
Ron DeSantis, Governor Tom Berger, Secretary
FORM 8 – PUR 7801 VENDOR CERTIFICATION FORM
FOR
MyFloridaNetwork-3
ITN NO: 26/27-025
THE STATE OF FLORIDA
DEPARTMENT OF MANAGEMENT SERVICES
Vendor Certification Form
I hereby certify the following on behalf of the vendor identified below:
| Customer Indicator (Required, N/A, Determined by Vendor) |
| Vendor Indicator (Certified, N/A) |
| Certification |
| Choose an item. | |
| Choose an item. | Regardless of the dollar value of the goods or services provided, in accordance with the requirements of section 287.135(5), F.S., the vendor is not participating in a boycott of Israel and is not on the State Board of Administration’s “Quarterly List of Scrutinized Companies that Boycott Israel,” available at https://www.sbafla.com/governance/global-governance-mandates/ |
| Choose an item. | |
| Choose an item. | If the goods or services to be provided are $1 million or more, in accordance with the requirements of section 287.135, F.S., the vendor is not on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Terrorism Sectors List (collectively, “Scrutinized List of Prohibited Companies”); does not have business operations in Cuba or Syria; and is not on the State Board of Administration’s “Scrutinized List of Prohibited Companies” available under the quarterly reports section at https://www.sbafla.com/reporting/ |
| Choose an item. | |
| Choose an item. | The vendor is not on the Suspended Vendor List; it and its suppliers, subcontractors, or consultants to be utilized under the contract are not on the Convicted Vendor, Discriminatory Vendor, or Antitrust Violator Vendor Lists; and there is no pending or threatened action, proceeding, or investigation, or any other legal or financial condition, that would in any way prohibit, restrain, or diminish the vendor’s ability to satisfy the contract obligations. |
The vendor is hereby informed of the provisions of sections 287.133(2)(a), 287.134(2)(a), and 287.137(2)(a), F.S., that identify the impacts to the vendor's ability or its affiliates’ ability to respond to the competitive solicitations of a public entity; to be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with a public entity; or to transact business with a public entity if it, or its affiliates, are placed on the Convicted Vendor, Discriminatory Vendor, or Antitrust Violator Vendor Lists of the Department of Management Services. The vendor is hereby further informed of the provisions of section 287.1351, F.S., that identify the impacts to the vendor’s ability to enter into or renew a contract with an agency, as defined in section 287.012, F.S., if it is placed on the Suspended Vendor List of the Department of Management Services.
| Choose an item. | |
| Choose an item. | If the contract grants the vendor access to an individual’s personal identifying information, the vendor is not prohibited from entering into the contract pursuant to section 287.138, F.S., and has completed the Form PUR 1355, “Foreign Country of Concern Attestation Form,” available at http://www.flrules.org/Gateway/reference.asp?No=Ref-15843, and attached it hereto. |
| Choose an item. | |
| Choose an item. | If the vendor is a common carrier, as defined in section 908.111, F.S., or a contracted carrier, it is not prohibited from entering into the contract pursuant to section 908.111, F.S., and has completed the Form PUR 1808, “Common Carrier or Contracted Carrier Attestation Form,” available at http://www.flrules.org/Gateway/reference.asp?No=Ref-14614, and attached it hereto. |
| Choose an item. | |
| Choose an item. | The vendor is registered with, and uses, the E-Verify system for all newly hired employees in accordance with section 448.095, F.S.; and has not, within the last year, had a contract terminated under section 448.095(5)(c), F.S., by a public employer, contractor, or subcontractor, as defined by section 448.095(1), F.S. |
| Choose an item. | |
| Choose an item. | The vendor is in compliance with all applicable disclosure requirements set forth in section 286.101, F.S., and has not been deemed ineligible for a grant or contract funded by a state agency pursuant to section 286.101(7), F.S. |
| Choose an item. | |
| Choose an item. | If the contract is between a nongovernmental entity and a governmental entity, in accordance with section 787.06, F.S., the vendor has completed an affidavit signed by an officer or a representative of the vendor under penalty of perjury attesting that the vendor does not use coercion for labor or services as defined in section 787.06, F.S. |
[the Customer may add rows to this table for additional certifications required by law or rule]
By signing below, I certify that I am authorized to complete and submit this Vendor Certification Form on behalf of the vendor.
Vendor Information Signatory
Name Signature Date
FEIN Typed or Printed Name
Title
ITN No.: DMS-26/27-025 Page 2 of 13
PUR 7801 VENDOR CERTIFICATION FORM
ITN No.: DMS-26/27-025 Page 2 of 7
PUR 7801 VENDOR CERTIFICATION FORM
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