Form 2 - Vendor Certification.pdf

FORM 2 – Vendor Certification

1. The Respondent certifies that it 1) has a current and active registration with the Florida Department of State, Division of Corporations, 2) if awarded a Contract, will have a current and active registration prior to execution of the Contract, or 3) will certify to the Division that it is exempt from registration. www.sunbiz.org

2. The Respondent certifies that it is not on the Discriminatory Vendor List or on the Convicted Vendor List and is not prohibited from performing any of the actions contemplated in sections 7 and 8 of the PUR 1001.

http://www.dms.myflorida.com/content/download/2934/11780/1001.pdf

3. The Respondent certifies that it is not on the Antitrust Violator Vendor List pursuant to section 287.137, Florida Statutes and is not prohibited from performing any of the actions contemplated in section 9 of the PUR 1001.

4. The Respondent certifies that it 1) is not on the Scrutinized Companies with Activities in Sudan List pursuant to section 215.473, Florida Statutes, 2) is not on the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List pursuant to section 215.473, F.S., 3) is not on the Scrutinized Companies that Boycott Israel List pursuant to section 215.4725, F.S., and 4) is not participating in a boycott of Israel.

5. The Respondent certifies that it is not on the Suspended Vendor List, pursuant to Rule 60A- 1.006, Florida Administrative Code (F.A.C.). The Suspended Vendor List is accessible at:

https://www.dms.myflorida.com/business_operations/state_purchasing/state_agency_resources/vendor_registration _and_vendor_lists/suspended_vendor_list

6. The Respondent certifies that it complies with the provisions of chapter 112, Florida Statutes, Conflict of Interest, and no conflict of interest exists or has notified the Procurement Officer of any potential conflict.

7. The Respondent certifies that it currently has no delinquent obligations to the State, including a claim by the State for liquidated damages under any other contract.

8. The Respondent certifies that it is in compliance with section 448.095(2)(a), Florida Statutes, and that within the last year (i.e., within the last 365 days), it has not had a contract terminated under section 448.095(2)(c), Florida Statutes, by a public employer, as defined by section 448.095(1)(i), Florida Statutes.

9. The Respondent certifies that the Respondent has read, understood, and agrees to all requirements of the solicitation and agrees to all terms and conditions.

10. The Respondent certifies that the number of the years of experience and response times as indicated in their technical response to the RFP is accurate.

Signature below certifies that the signatory has the authority to respond to this solicitation on the Respondent’s behalf and certifies conformance with all Responsive Requirements listed above.

Company Name

Name of Respondent’s Authorized Representative

Signature of Respondent’s Authorized Representative Date

RFP-DEM-22-23-025 Page 1 of 1 http://www.sunbiz.org/ https://www.dms.myflorida.com/business_operations/state_purchasing/state_agency_resources/vendor_registration_and_vendor_lists/discriminatory_vendor_list) https://www.dms.myflorida.com/content/download/2934/11780/PUR_1001_General_Instructions_to_Respondents.pdf http://www.dms.myflorida.com/content/download/2934/11780/1001.pdf https://www.dms.myflorida.com/content/download/2934/11780/PUR_1001_General_Instructions_to_Respondents.pdf https://www.dms.myflorida.com/business_operations/state_purchasing/state_agency_resources/vendor_registration_and_vendor_lists/suspended_vendor_list https://www.dms.myflorida.com/business_operations/state_purchasing/state_agency_resources/vendor_registration_and_vendor_lists/suspended_vendor_list

FORM 2 – Vendor Certification