GISD - New Building Fiber 2019 - 05 - Attachment D - Vendor Certification.pdf
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- 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 a vendor certification form issued by the Genesee Intermediate School District (GISD) located in Flint, Michigan, required for bidders on the New Building Fiber 2019-05 project. The certification document serves as a compliance requirement for all prospective contractors and vendors submitting bids for services to the school district. Bidders must complete the form with their company information, including name, address, contact number, and the authorized representative who can bind the contractor to a binding bid agreement. The form requires notarization and sworn certification before submission, with any bids lacking this executed certification being deemed non-compliant and ineligible for consideration.
The primary purpose of this certification is to establish compliance with Michigan's Iran Economic Sanctions Act (MCL 129.311, et seq.), requiring bidders to certify that their organization is not an Iran-linked business as defined under state law. Bidders acknowledge their understanding that submission of false certification may result in severe penalties, including contract termination, three-year bidding ineligibility, civil penalties of $250,000 or twice the bid amount (whichever is greater), plus investigation and legal costs. The document must be notarized by a public notary in the appropriate county and include the notary's signature, date, commission expiration, and acting county designation to be valid for bid submission.
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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 .