Iran Affidavit.pdf

IRAN LINKED BUSINESS AFFIDAVIT

All Bids shall be accompanied by a sworn statement disclosing any Iran Linked Business relationship that exists within the owners, including its officers, directors and employees.

The undersigned, owner or authorized officer of _________________________________ (the bidder), pursuant to Michigan Public Act No. 517 of 2012, the “Iran Linked Business” hereby represents and warrants that the bidder, including its officers, directors and employees, is not an “Iran Linked Business” within the meaning of the applicable Public Act, and that in the event bidder is awarded a contract as a result of this RFP, the bidder will not become an “Iran Linked Business” at any time during the course of performing under the contract. The bidder further acknowledges that any person who is found to have submitted a false certification is responsible for a civil penalty of not more than $250,000.00 or 2 times the amount of the contract or proposed contract for which the false certification was made, whichever is greater, the cost of the District investigation, and reasonable attorney fees, in addition to the fine.

Moreover, any person who submitted a false certification shall be ineligible to bid on future Requests for Proposals (RFPs) for three (3) years from the date that it is determined that the person has submitted the false certification.

There is not an “Iran Linked Business” that exists within the bidder and/or owner, officers, directors and employees.

Bidder: ___________________________________________________ (Company Name)

By: ___________________________________________________ (Signature)

(Title)

This instrument was acknowledged before me, a Notary Public, in and for

______________________ County, on this _____day of ___________________, 20__, ______________________________________________ SS:

(Notary Public Signature)

My Commission expires: _________________________

Acting in the County of: __________________________