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, Fife Lake Village, Michigan
About this file
This is a vendor certification form for the GenNET Backup Equipment RFP 2019-05 issued by the Genesee Intermediate School District located in Flint, Michigan. The document serves as Attachment D to the request for proposals and requires vendors to certify their compliance with Public Act 517 of 2012, the Iran Economic Sanctions Act. Bidders must confirm that they are not Iran-linked businesses as defined under MCL 129.311, et seq., and must provide their company name, address, contact number, and authorized signatory information. The certification must be sworn and notarized, with the notary public completing their portion of the form including county, date, and commission expiration information. Any bids submitted without this completed and notarized certification will not be accepted by the school district.
Submission of false certification carries significant penalties, including contract termination, ineligibility to bid for three years, and a civil penalty of $250,000 or twice the bid amount, whichever is greater, plus investigation and legal costs. The school district will rely on vendor representations during bid evaluation. The form contains blank fields for contractors and vendors to complete with their identifying information and authorized representative details, signature, and date.
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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
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