Iran Free Procurement Certification Form (1).pdf
PDF 26 KB Posted
- Attached to
- Columbia County Pipe Lining Project State and local contract opportunity
- Solicitation number
- 6100066365
- Issued by
- Columbia County, Pennsylvania
About this file
This is an Iran Free Procurement Certification Form required by the Pennsylvania Department of General Services under Pennsylvania's Procurement Code Sections 3501-3506 for vendors seeking contracts with Commonwealth entities valued at $1,000,000 or more. The certification applies to the Columbia County Pipe Lining Project administered by the Pennsylvania Department of Transportation, which involves the repair of pipe culverts on SR 4009 through installation of High-Density Polyethylene pipe culvert liners and grouting of annular space between existing and liner pipes. The project encompasses four pipe segments totaling 614 linear feet: Pipe 1 consists of 235 linear feet of 18-inch corrugated steel culvert pipe; Pipe 2 comprises 117 linear feet of 18-inch corrugated steel culvert pipe; Pipe 3 includes 166 linear feet of 24-inch corrugated steel culvert pipe; and Pipe 4 consists of 96 linear feet of 24-inch corrugated steel culvert pipe. Materials must be sourced from manufacturers listed in PennDOT Publication 35 (Bulletin 15), Section 601.2(a)6.a for the liner and Section 220.2(d) for grouting products.
Vendors must complete either Option 1 by certifying they are not engaged in investment activities in Iran and are eligible to contract with the Commonwealth, or Option 2 by demonstrating receipt of a written exemption from the certification requirement on a case-by-case basis. Pennsylvania law imposes significant penalties for false certifications, including civil penalties equal to the greater of $250,000 or twice the contract amount, contract termination, and three-year ineligibility to bid on future contracts. All authorized representatives executing the certification must provide printed name, title, and execution date.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| Scope of Work.pdf | ||
| Pipeline Pic 1.pdf | ||
| Worker Protection and Investment Certification Form (BOP 2201) (1).docx | DOCX document | |
| Trade Secret - Confidential Proprietary Information Form (1).pdf | ||
| Pipeline Pic 3.pdf | ||
| Pipeline Pic 2.pdf | ||
| Pipeline Pic 4.pdf | ||
| OS-501 Confirmation of Service.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
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