FORM_7_SCRUTINIZED_COMPANIES_CERTIFICATION.pdf
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- Solicitation number
- 26-0068BW
- Issued by
- Lee County, Fruitville CDP, Florida
About this file
This is a Scrutinized Companies Certification form (Form 7) required for RFQ 26-0068BW submitted to the Lee County Port Authority in Florida for General Planning and Environmental Services. The certification serves as a mandatory compliance document that respondents must complete and submit as part of their qualifications package.
The form requires respondents to certify under penalties of perjury that they have 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 Florida Statutes Section 287.135, are not engaged in business operations in Cuba and Syria, and will not engage in "Boycott Israel" activities as defined in Florida Statutes Section 215.4725 that would result in placement on the Scrutinized Companies that Boycott Israel List. Respondents must affirm they are authorized to submit the certification on behalf of their company and are ready, willing, and able to perform if awarded the contract. The form requires notarization and must be signed by both the respondent and a notary public. Falsification of this certification may result in contract termination, debarment from submitting qualifications for three years, civil penalties, and assessment of attorney's fees and costs. Respondents are further required to inform the Lee County Port Authority prior to contract execution of any changes to the information contained in the certification.
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Text version
RFQ 26-0068BW: GENERAL PLANNING AND ENVIRONMENTAL SERVICES FOR THE LEE COUNTY PORT AUTHORITY
FORM 7: SCRUTINIZED COMPANIES CERTIFICATION
Respondent hereby certifies under penalties of perjury as of the date of submission of its RFQ 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 Respondent 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 Qualifications.
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 QUALIFICATIONS 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: 3.4.2026 Page 46 of 48
| COUNTY OF: |
| online notarization who produced the following as identification: |
| type of identification or is personally known to me: |
| My Commission Expires: |
| Typed or printed name: |
| Count of: |
| Of: |
| this day: |
| Year: |
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