Iran Economic Sanctions Act Affidavit.pdf
PDF 89 KB Posted
- Attached to
- FY27 USF Bid
- Solicitation number
- RFP WLC 260000002423 1
- Issued by
- Berrien County, Michigan
About this file
This is an Iran Economic Sanctions Act Affidavit of Compliance required by the Walled Lake Consolidated School District in Michigan for participation in an Invitation for Bids (IFB) for the Purchase of Musical Instruments. The affidavit certifies that the bidder, including all officers, directors, and employees, is not an "Iran linked business" as defined under Michigan Public Act No. 517 of 2012 and commits to maintaining this status throughout contract performance. The document requires the bidder's authorized representative to execute the affidavit before a notary public, with specific fields for bidder name, signature, title, date, and notarial acknowledgment details.
Bidders who submit false certifications face significant penalties including civil fines up to $250,000 or twice the contract amount (whichever is greater), responsibility for the School District's investigation costs and attorney fees, and three-year ineligibility from bidding on future requests for proposals. This compliance requirement is a mandatory condition of bid submission and contract award eligibility for the FY27 USF Bid in Michigan.
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Other files
| File | Type | Posted |
|---|---|---|
| FY27 RFP Walled Lake IA.pdf | ||
| Familial Disclosure Affidavit.pdf |
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Text version
IRAN ECONOMIC SANCTIONS ACT AFFIDAVIT OF COMPLIANCE
Michigan Public Act No. 517 of 2012
The undersigned, the owner or authorized officer of the below-named Bidder (“Bidder”), pursuant to the compliance certification requirement provided in the Walled Lake Consolidated School District’s (the “School District”) Invitation for Bids for the Purchase of Musical Instruments (the “IFB”), hereby certifies, represents and warrants that the Bidder (including its officers, directors and employees) is not an “Iran linked business” within the meaning of the Iran Economic Sanctions Act, Michigan Public Act No. 517 of 2012 (the “Act”), and that in the event Bidder is awarded a contract as a result of the aforementioned IFB, the Bidder will not become an “Iran linked business” at any time during the course of performing any Work 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 School District’s investigation, and reasonable attorney fees, in addition to the fine. Moreover, any person who submitted a false certification shall be ineligible to bid on a request for proposal for three (3) years from the date the it is determined that the person has submitted the false certification.
BIDDER:
Name of Bidder
By:
Its:
Date:
STATE OF )
) ss.
COUNTY OF ____________ )
This instrument was acknowledged before me on the _____ day of ____________, 20__, by
, Notary Public
______________ County, My Commission Expires:
Acting in the County of
| Name of Bidder: |
| By: |
| Its: |
| STATE OF: |
| Date: |
| COUNTY OF: |
| undefined: |
| Notary Public: |
| My Commission Expires: |
| Acting in the County of: |
| Day: |
| Month: |
| State: |
| County: |
| Year: |
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