GISD - New Building Low Voltage 2019 - 05 - Attachment D - Vendor Certification.pdf
PDF 14 KB Posted
- Attached to
- CCP New Building Low Voltage & AV Equipment
- Solicitation number
- RFP GIS 190000002251 3
- Issued by
- Genesee County, Flint City, Michigan
About this file
This is a vendor certification form for the Genesee Intermediate School District (GISD) located in Flint, Michigan, used for the New Building Low Voltage 2019-05 project. The document serves as a sworn certification that bidders must submit to be considered for contract award. Bidders are required to certify their compliance with the Iran Economic Sanctions Act (MCL 129.311, et seq.) and confirm that they are not an Iran-linked business as defined by the Act. The form requires submission of detailed contractor or vendor information, including company name, address, contact number, and the authorized representative's signature. Notarization is mandatory, requiring a notary public to acknowledge the certification before a specified county official, with the notary's commission expiration date and county of operation noted on the form.
The certification explicitly states that bids submitted without this sworn and notarized form will not be accepted. Bidders acknowledge that GISD will rely on the accuracy of their representations in evaluating proposals. False certification carries 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 associated investigation and legal costs. This document is a compliance requirement rather than a pricing or terms document and does not contain information regarding contract value, budget, timeline, or other commercial terms.
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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 .