Iran and Disclosure.pdf
PDF 26 KB Posted
- Attached to
- Garber Office Renovation
- Solicitation number
- RFP-EHP-180000002330-3
- Issued by
- Bay County, Elsie Village, Michigan
About this file
This document is a combined Familial Disclosure Statement and Iran Economic Sanctions Act Certification for a building entry installation services bid for Essexville Hampton Public Schools in Michigan. The document appears to be a required affidavit for potential contractors bidding on an interior lock master rekey/replacement project, which involves completing disclosure statements about familial relationships between the contractor's owners/employees and school district leadership, as well as certifying that the bidder is not an Iran-linked business.
The certification requires bidders to provide transparency about potential conflicts of interest and compliance with economic sanctions. Contractors must disclose any familial relationships with school district superintendents or board members and affirm they are not an Iran-linked business. False certifications can result in significant penalties, including contract termination, three-year bidding ineligibility, and potential civil penalties up to $250,000 or twice the bid amount. The document is structured to ensure vendor accountability and compliance with state procurement regulations through mandatory sworn statements and potential legal consequences for misrepresentation.
View the file
Other files
Show all 12
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
ATTACHMENT “A”
[Familial Disclosure Statement]
AFFIDAVIT OF ______________________________
(insert name of affiant)
STATE OF MICHIGAN )
)ss
COUNTY OF _________________ )
___________________________________ makes this Affidavit under oath and states as follows:
(insert name of affiant)
1. I am a/the:
G President G Vice-President G Chief Executive Officer G Member G Partner G Owner G Other (please specify) ________________________ of [insert name of contractor], a bidder for building entry installation services for Essexville
Hampton Public Schools.
2. I have personal knowledge and/or I have personally verified that the following are all of the familial relationships existing between the owner(s) and the employee(s) of the aforementioned contractor and the school district's superintendent and/or board members:
3. I have authority to bind the aforementioned contractor with the representations contained herein, and I am fully aware that the school district will rely on my representations in evaluating bids for the required services.
4. I declare the above information to be true to the best of my knowledge, information and belief. I could completely and accurately testify regarding the information contained in this affidavit if requested to do so.
(signature of affiant)
Dated: ________________
Subscribed and sworn before me in _________________ County, Michigan, on the ___ day of _________________, 201____ ____________________________________________(signature) _____________________________________________ (printed) Notary public, State of Michigan, County of ________________ My Commission expires on _____________________________ Acting in the County of ________________________________
ATTACHMENT “B”
[Iran Economic Sanctions Act Certification]
I am the _______(title)________ of _____________(bidder)_______________, or I am bidding in my individual capacity ("Bidder"), with authority to submit a binding bid for the installation of Interior Lock Master Rekey/replace to Essexville Hampton Public Schools. 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.
(signature)
(printed)
(date)
File details come from the government source that posted it. Updated .