GenNET Backup Equipment RFP 2019 - 05 - Attachment D - Vendor Certificat....pdf
PDF 14 KB Posted
- Attached to
- GenNET Backup Equipment
- Solicitation number
- RFP-GIS-190000002755-1
- Issued by
- Genesee County, Michigan
About this file
The document is a Public Act 517 of 2012 Iran Economic Sanctions Act Certification form from the Genesee Intermediate School District (GISD) located in Flint, Michigan. The form is designed to certify that potential bidders or contractors are not an "Iran-linked business" as defined by Michigan law, which is a mandatory requirement for participating in the school district's bidding process.
The certification requires bidders to swear and have notarized a statement confirming they are not conducting business with Iran. Failure to submit this completed form will result in bid disqualification. The document outlines significant potential penalties for false certification, including contract termination, three-year bidding ineligibility, and a civil penalty of $250,000 or twice the bid amount, whichever is greater. The form must be completed with the bidder's full contact information, authorized representative details, and notarized to be considered valid.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
GENESEE INTERMEDIATE SCHOOL DISTRICT
ERWIN L. DAVIS EDUCATION CENTER
2413 WEST MAPLE AVENUE
FLINT, MI 48507-3493
PUBLIC ACT 517 OF 2012
IRAN ECONOMIC SANCTIONS ACT CERTIFICATION
I am the Click here to enter text of Click here to enter text, or I am bidding in my individual capacity ("Bidder"), with authority to submit a binding bid for the provision of Click here to enter text. services to Genesee Intermediate School District. I have personal knowledge of the matters described in this Certification, and I am familiar with the Iran Economic Sanctions Act, MCL 129.311, et seq. ("Act"). I am fully aware that the school district will rely on my representations in evaluating bids.
I certify that Bidder is not an Iran-linked business, as that term is defined in the Act. I understand that submission of a false certification may result in contract termination, ineligibility to bid for three (3) years, and a civil penalty of $250,000 or twice the bid amount, whichever is greater, plus related investigation and legal costs.
Any bids that do not include this sworn and notarized Certification shall not be accepted.
Owner Name & Address:
Genesee Intermediate School District 2413 West Maple Avenue
Flint, MI 48507-3493
Contractor/Vendor/Respondent Information:
Name: ______________________________________________________________________
Address: ____________________________________________________________________
Contact Number: ______________________________________________________________
Person Authorized to Bind the Contractor/Vendor/Respondent:
Print Name Title
Signature Date
Seal:
This instrument was acknowledged before me, a Notary Public, in and for ___________________________ County, _____________________ on this _________ day of ________________________, 20_________.
State
Notary Public Signature Date
My Commission Expires: _______________________
Acting in the County of: ________________________
Attachment D
File details come from the government source that posted it. Updated .