GenNET Fiber Maintenance RFP 2018 - 05 - Attachment D - Vendor Certification.pdf
PDF 14 KB Posted
- Attached to
- Fiber Maintenance
- Solicitation number
- RFP GIS 190000000453 2
- Issued by
- Genesee County, Flint City, Michigan
About this file
This is a Vendor Certification form for the GenNET Fiber Maintenance RFP 2018-05 issued by the Genesee Intermediate School District located at 2413 West Maple Avenue in Flint, Michigan. The form serves as a mandatory certification document that bidders must complete and submit with their proposals for fiber maintenance services. The certification requires bidders to provide their organization name, address, contact information, and the name and title of the person authorized to execute binding agreements on behalf of the contractor or vendor. All bids that do not include this sworn and notarized certification will not be accepted by the district.
The certification requires bidders to affirm under oath that they are not an Iran-linked business as defined by the Iran Economic Sanctions Act (MCL 129.311, et seq.). Bidders must acknowledge their familiarity with this act and confirm they have personal knowledge of the representations made in the certification. False certifications carry significant penalties, including contract termination, ineligibility to bid for three years, and civil penalties of $250,000 or twice the bid amount, whichever is greater, plus investigation and legal costs. The form must be notarized before a Notary Public, with the notary providing their signature, commission expiration date, and the county in which the acknowledgment was made.
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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
File details come from the government source that posted it. Updated .