GISD - New Building Fiber 2019 - 05 - Attachment D - Vendor Certification.pdf
PDF 14 KB Posted
- Attached to
- GISD New Building Fiber RFP
- Solicitation number
- RFP-GIS-190000001564-2
- Issued by
- Genesee County, Flint City, Michigan
About this file
This is an Iran Economic Sanctions Act Certification form required by Public Act 517 of 2012 for the Genesee Intermediate School District, located at the Erwin L. Davis Education Center in Flint, Michigan. The document is a mandatory certification that must be completed, sworn, and notarized by any bidder seeking to provide services to the school district.
The form requires bidders to certify that they are not an Iran-linked business as defined by MCL 129.311. Failure to include this certification will result in bid rejection. The document includes serious 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 detailed contractor/vendor information, authorized signature, and notarization with seal.
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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 .