Iran Free Certification Form.pdf
PDF 29 KB Posted
- Attached to
- 12 8600 Driver Education Services CTI
- Solicitation number
- 6100065058
- Issued by
- Carbon County, Pennsylvania
About this file
This is an Iran Free Certification Form required by the Commonwealth of Pennsylvania under Sections 3501-3506 of the Procurement Code for vendors seeking contracts with Commonwealth entities valued at $1,000,000 or more. The form applies to the Department of Labor and Industry, Office of Vocational Rehabilitation, Commonwealth Technical Institute (CTI) located at the Hiram G Andrews Center in Johnstown, Pennsylvania, which is soliciting driving instructor services for the period of March 2026 through December 2029. The procurement encompasses driving services, classroom training, and classroom materials for CTI students. The estimated quantities and specific response deadlines are not detailed in this certification form; however, vendors must complete and submit this certification along with other required documents including the Statement of Work, Worker Protection Form, and Trade Secret Form.
Vendors must certify under Option #1 that they are not on the current list of persons engaged in investment activities in Iran maintained by the Pennsylvania Department of General Services, or alternatively under Option #2 demonstrate receipt of a written exemption from DGS under Section 3503(e). This procurement is reserved exclusively for DGS Small Businesses, requiring bidders to attach their Small Business Certificate to be deemed eligible. Pennsylvania law imposes significant penalties for false certifications, including civil penalties of the greater of $250,000 or twice the contract amount, contract termination, and three-year ineligibility to bid on future contracts. The Commonwealth reserves the right to adjust quantities based on actual requirements and to pursue separate competitive procurement procedures at its discretion.
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Other files
| File | Type | Posted |
|---|---|---|
| Cambria HGAC Driving Services SOW.pdf | ||
| Trade Secret Form.pdf | ||
| Workers Protect Form.pdf | ||
| Cambria HGAC Driving Services T&C.pdf |
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Text version
BOP-1701
Published: 1/26/2017
IRAN FREE PROCUREMENT CERTIFICATION FORM
(Pennsylvania’s Procurement Code Sections 3501-3506, 62 Pa.C.S. §§ 3501-3506)
To be eligible for an award of a contract with a Commonwealth entity for goods or services worth at least $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 Pennsylvania Department of General Services (“DGS”) pursuant to Section 3503 of the Procurement Code and is eligible to contract with the Commonwealth under Sections 3501-3506 of the Procurement Code; or b) demonstrate it has received an exception from the certification requirement for that solicitation or contract pursuant to Section 3503(e).
To comply with this requirement, please insert your vendor or financial institution name and complete one of the options below. Please note: Pennsylvania 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. (Section 3503 of the Procurement Code.)
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 eligible to contract with the Commonwealth of Pennsylvania Sections 3501-3506 of the Procurement Code.
Vendor Name/Financial Institution (Printed)
By (Authorized Signature)
Printed Name and Title of Person Signing Date Executed
OPTION #2 – EXEMPTION
Pursuant to Procurement Code Section 3503(e), DGS may permit a vendor/financial institution engaged in investment activities in Iran, on a case-by-case basis, to enter into a contract for goods and services.
If you have obtained a written exemption from the certification requirement, please fill out the information below, and attach the written documentation demonstrating the exemption approval.
Vendor Name/Financial Institution (Printed)
By (Authorized Signature)
Printed Name and Title of Person Signing Date Executed
| IRAN FREE PROCUREMENT CERTIFICATION FORM |
| (Pennsylvania’s Procurement Code Sections 3501-3506, 62 Pa.C.S. §§ 3501-3506) |
| OPTION #1 - CERTIFICATION |
| OPTION #2 – EXEMPTION |
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