Iran_Contracting_Act_Verification_Form.pdf
PDF 139 KB Posted
- Attached to
- Office Supplies/Arts and Crafts Warehouse Stock
- Solicitation number
- Bid 3087
- Issued by
- Fresno County, California
About this file
This is an Iran Contracting Act Certification form required by the State of California for contracts valued at $1,000,000 or more under Public Contract Code sections 2202-2208. The form applies to BID No. 3087 for Office Supplies/Arts and Crafts Warehouse Stock issued by CUSD (Chula Vista Unified School District). All bidders must register through CUSD's eProcurement Portal at https://www.cusd.com/bid-schedule and submit bids electronically. The certification form requires bidders to execute either Option #1 (standard certification) or Option #2 (exemption documentation) prior to bid submission, with the authorized signatory providing their printed name, title, and date of execution.
Under Option #1, bidders must certify that they are not listed on the California Department of General Services' current list of persons engaged in investment activities in Iran and are not financial institutions extending $20,000,000 or more in credit to persons identified on that list for energy sector activities in Iran. Option #2 permits bidders with Iran investment activities to submit an exemption request on a case-by-case basis with supporting documentation of exemption approval from the public entity. California law imposes significant penalties for false certifications, including civil penalties of the greater of $250,000 or twice the contract amount, contract termination, and a three-year ban from bidding on future contracts.
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IRAN CONTRACTING ACT CERTIFICATION
(Public Contract Code sections 2202-2208)
(To be Executed by Bidder and Submitted With Bid)
As required by Public Contract Code (“PCC”) section 2204 for contracts of $1,000,000 or more, please insert bidder’s or financial institution’s name and Federal ID Number (if available) and complete one of the options below. Please note that 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. (PCC §2205.)
OPTION #1 - CERTIFICATION
I, the official named below, certify I am duly authorized to execute this certification on behalf of the bidder/financial institution identified below, and the bidder/financial institution identified below is not on the current list of persons engaged in investment activities in Iran created by California Department of General Services (“DGS”) and is not a financial institution extending twenty million dollars ($20,000,000) or more in credit to another person/bidder, for 45 days or more, if that other person/bidder 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. (PCC §2204(a).)
Bidder Name/Financial Institution (Printed) Federal ID Number (or n/a)
By (Authorized Signature)
Printed Name and Title of Person Signing
Date Executed Executed in
OPTION #2 – EXEMPTION
Pursuant to Public Contract Code sections 2203(c) and (d), a public entity may permit a bidder/financial institution engaged in investment activities in Iran, on a case-by-case basis, to be eligible for, or to bid on, submit a proposal for, or enters into or renews, a contract for goods and services. If you have obtained an exemption from the certification requirement under the Iran Contracting Act, please fill out the information below, and attach documentation demonstrating the exemption approval.
Bidder Name/Financial Institution (Printed) Federal ID Number (or n/a)
By (Authorized Signature)
Printed Name and Title of Person Signing Date Executed
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