Iran_Contracting_Act_Certification.pdf

141 KB Posted

Attached to
25CRY016 - Temporary Relief Cook Staffing Services
Solicitation number
0000036336
Issued by
Alameda County, Contra Costa County, Marin County, Mendocino County, Napa County, San Francisco County, Solano County, Sonoma County, Yolo County, Alameda City, Contra Costa Centre CDP, Marina Del Rey CDP, San Marino City, Lucas Valley-Marinwood CDP, Marin City CDP, Mendocino CDP, Marina City, Napa City, San Francisco City, South San Francisco City, Sonoma City, Sonoma State University CDP, Yolo CDP, California

About this file

Written by GovTribe AI ·

This document is an Iran Contracting Act Verification Form issued by the California Department of General Services (DGS) for Solicitation Number 25CRY016. The form is a mandatory certification required for vendors or financial institutions bidding on, submitting a proposal for, or executing a State of California contract valued at $1,000,000 or more.

The form requires vendors to certify that they are not on the current list of persons engaged in investment activities in Iran and are not a financial institution extending $20,000,000 or more in credit to another entity for use in Iran's energy sector. The document outlines two options for compliance: Option #1 involves direct certification of non-involvement, while Option #2 provides a potential exemption pathway on a case-by-case basis. California law establishes significant penalties for false certifications, including civil penalties up to $250,000 or twice the contract amount, contract termination, and a three-year prohibition on bidding for contracts.

View the file

Other files

File Type Posted
DVBE_ProgramRequirements_-_Contracts.pdf PDF
STD_204_-_Payee_Data_Record.pdf PDF
Sample_Insurance_Template.pdf PDF
California_Civil_Rights_Laws_Certification.pdf PDF
Bid_Rate_Sheet_-Final.xlsx XLSX spreadsheet
Bidder_Certification.pdf PDF
Contractor_Certification_Clauses_(CCC).pdf PDF
Non-Collusion_Declaration.pdf PDF
Bidder_Declaration_-_GSPD-05-105.pdf PDF
Bidder_s_Checklist.pdf PDF
Commercially_Useful_Function_(CUF)_Certification_Form.pdf PDF
DGS_PD_843_-_DVBE_Declarations.pdf PDF
Darfur_Contracting_Act.pdf PDF
Exhibits_A_-_D.pdf PDF
IFB_-_Notice_to_Prospective_Bidders.pdf PDF
STD_205_-_Payee_Data_Record_Supplement.pdf PDF
STD_213_(Sample).pdf PDF
Show all 17

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file
Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

STATE OF CALIFORNIA

IRAN CONTRACTING ACT VERIFICATION FORM

DGS PD 3 (Rev. 12/19)

DEPARTMENT OF GENERAL

SERVICES PRCUREMENT DIVISION

Solicitation Number: 25CRY016

(Public Contract Code sections 2202-2208)

Prior to bidding on, submitting a proposal or executing a contract or renewal for a State of California contract for goods or services of $1,000,000 or more, a vendor must either: a) certify it is not on the current list of persons engaged in investment activities in Iran created by the California Department of General Services ("DGS") pursuant to Public Contract Code section 2203(b) and is not a financial institution extending twenty million dollars ($20,000,000) or more in credit to another person, for 45 days or more, if that other person will use the credit to provide goods or services in the energy sector in Iran and is identified on the current list of persons engaged in investment activities in Iran created by DGS; or b) demonstrate it has been exempted from the certification requirement for that solicitation or contract pursuant to Public Contract Code section 2203(c) or (d). The DGS list of entities prohibited from contracting with public entities in California per the Iranian Contracting Act, 2010, can be found at:

Department of General Services Procurement Division Iran Contracting Act List (http://www.documents.dgs.ca.gov/PD/poliproc/lran%20Contracting%20Act%20List.pdf)

To comply with this requirement, please insert your vendor or financial institution name and Federal ID Number (if available) and complete one of the options below.

Please note: California law establishes penalties for providing false certifications, including civil penalties equal to the greater of $250,000 or twice the amount of the contract for which the false certification was made; contract termination; and three-year ineligibility to bid on contracts. (Public Contract Code section 2205.)

OPTION #1 - CERTIFICATION

I, the official named below, certify I am duly authorized to execute this certification on behalf of the vendor/financial institution identified below, and the vendor/financial institution identified below is not on the current list of persons engaged in investment activities in Iran created by DGS and is not a financial institution extending twenty million dollars ($20,000,000) or more in credit to another person/vendor, for 45 days or more, if that other person/vendor will use the credit to provide goods or services in the energy sector in Iran and is identified on the current list of persons engaged in investment activities in Iran created by

DGS.

Text1:
Text2:
Date3_af_date:
Text4:
Text5:
Text6:
Text7:
Date8_af_date:

File details come from the government source that posted it. Updated .