GenNET Telephone Services RFP 2019 - 05 - Attachment D - Vendor Certification.pdf
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- Attached to
- GenNET Telephone Service
- Solicitation number
- RFP-GIS-200000000373-2
- Issued by
- Genesee County, Michigan
About this file
This document is an Iran Economic Sanctions Act Certification form (Attachment D) required by the Genesee Intermediate School District in Flint, Michigan, in compliance with Public Act 517 of 2012. The form is a mandatory component of any bid submission to the Genesee Intermediate School District, requiring bidders to certify that they are not an Iran-linked business as defined by MCL 129.311.
The certification requires notarization and includes severe penalties for false certification, including contract termination, three-year bidding ineligibility, and civil penalties of $250,000 or twice the bid amount (whichever is greater) plus investigation and legal costs. The form requires complete contractor/vendor information including name, address, contact number, and authorized signature, followed by notary public acknowledgment sections. This document appears to be associated with a broader RFP for GenNET Telephone Services from 2019.
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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 .