Form_4_-_Scrutinized_Compnaies_Certification.pdf
PDF 108 KB Posted
- Solicitation number
- 26-0082MC
- Issued by
- Lee County, Fort Lauderdale City, Florida
About this file
This is a Scrutinized Companies Certification form required by the Lee County Port Authority for the Aircraft Rescue and Fire Fighting (ARFF) F3 Foam Transition project in Florida. The certification form serves as a compliance document whereby bidders and contractors must declare whether their company, or any of its officers, directors, or managers, have been placed on the Florida Scrutinized Companies List maintained by the Florida Department of State. Bidders are required to certify their status regarding scrutinized business practices and comply with Florida's contracting restrictions related to companies engaged in business operations in Iran, Sudan, or other sanctioned nations, as well as those engaged in boycotts of Israel or involved in unethical labor practices.
The form requires that contractors provide certification under penalty of perjury that they have not been identified as a scrutinized company and that they comply with all applicable state and federal regulations. Failure to complete and submit this certification form may result in bid rejection or contract termination. This documentation is a mandatory prerequisite for bid consideration on the ARFF foam transition project, which involves transitioning from aqueous film-forming foam (AFFF) to synthetic fluorine-free foam (SFFF) at Lee County Port Authority's two ARFF stations at Page Field (FMY) and Southwest Florida International Airport (RSW).
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Text version
RFP 26-0082MC: Aircraft Rescue and Fire Fighting (ARFF) F3 Foam Transition
FORM 4: SCRUTINIZED COMPANIES CERTIFICATION
Proposer hereby certifies under penalties of perjury as of the date of submission of its RFP to provide goods and services to Lee County Port Authority that it has not been placed on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List as defined in section 287.135, Florida Statutes, is not engaged in business operations in Cuba and Syria; and will not engage in “Boycott Israel” activities, as defined in section 215.4725 (1)(a), Florida Statutes, that result in proposer being placed on the Scrutinized Companies that Boycott Israel List created after October 1, 2016 and during the term of any contract awarded pursuant to this Request for Proposals.
I further certify that I am duly authorized to submit this certification on behalf of the company as its agent and that the company is ready, willing and able to perform if awarded a contract.
I UNDERSTAND THAT THE SUBMISSION OF THIS FORM TO THE PROCUREMENT OFFICE FOR LEE
COUNTY PORT AUTHORITY IS FOR THAT PUBLIC ENTITY ONLY AND, THAT FALSIFICATION OF
THIS CERTIFICATION MAY RESULT IN TERMINATION OF THE CONTRACT, DEBARMENT OF THE
COMPANY FROM SUBMITTING A BID OR PROPOSAL FOR A PERIOD OF THREE (3) YEARS FROM
THE DATE THE CERTIFICATION IS DETERMINED TO BE FALSE, CIVIL PENALTIES, AND THE
ASSESSMENT OF ATTORNEY’S FEES AND COSTS AGAINST THE COMPANY. I ALSO UNDERSTAND
THAT I AM REQUIRED TO INFORM LEE COUNTY PORT AUTHORITY PRIOR TO ENTERING INTO A
CONTRACT OF ANY CHANGE IN THE INFORMATION CONTAINED IN THIS FORM.
[Signature]
Notary Public
STATE OF ______________
COUNTY OF ____________
The foregoing instrument was signed and acknowledged before me this _______ day of _____________________, 20_____, by ____________________________________________ by means of physical presence or online notarization who produced the following as identification _________________________________ (type of identification) or is personally known to me.
My Commission Expires ________________ [stamp or seal]
[Signature of Notary Public]
[Typed or printed name]
Rev: 7.10.2026 Page 46 of 51
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| online notarization who produced the following as identification: |
| type of identification or is personally known to me: |
| My Commission Expires: |
| Typed or printed name: |
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| Check Box14: Off |
| Check Box15: Off |
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