Iran_Divestment_Act_Form.pdf

PDF 53 KB Posted

Attached to
West Forsyth High School HVAC Project
Solicitation number
260-260-042020242-401020
Issued by
Forsyth County, Winston-Salem City, North Carolina

About this file

The document is a Certification of Eligibility Under the Iran Divestment Act required for contracting with the State of North Carolina or any of its political subdivisions. The certification states that the vendor is not identified on the Final Divestment List of entities that engage in investment activities in Iran, and that the vendor will not utilize any subcontractor that is identified on the Final Divestment List.

The related state and local contract opportunity is for the West Forsyth High School HVAC Project, which involves upgrades to the HVAC system at West Forsyth School. The project is located in Forsyth County and Winston-Salem City in the state of North Carolina.

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MB Particpation Forms.doc DOC document
West Forsyth 600 Bldg Boiler Bid Form 260-042020242-401020.pdf PDF

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CERTIFICATION OF ELIGIBILITY

Under the Iran Divestment Act

Pursuant to G.S. 147-86.59, any person identified as engaging in investment activities in Iran, determined by appearing on the Final Divestment List created by the State Treasurer pursuant to G.S. 147-86.58, is ineligible to contract with the State of North Carolina or any political subdivision of the State. The Iran Divestment Act of 2015, G.S. 147-86.55 et seq.* requires that each vendor, prior to contracting with the State certify, and the undersigned on behalf of the

Vendor does hereby certify, to the following:

1. that the vendor is not identified on the Final Divestment List of entities that the State

Treasurer has determined engages in investment activities in Iran;

2. that the vendor shall not utilize on any contract with the State agency any subcontractor that is identified on the Final Divestment List; and

3. that the undersigned is authorized by the Vendor to make this Certification.

Vendor: ___________________________

By: ____________________________________________ __________________________

Signature Date

Printed Name Title

The State Treasurer’s Final Divestment List can be found on the State Treasurer’s website at the address:

astroupe Text Box https://www.nctreasurer.com/media/2798/download

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