Iran Free Procurement Certification Form (BOP 1701).pdf
PDF 29 KB Posted
- Attached to
- Replacement Plexiglass for Play Stations
- Solicitation number
- 6100066383
- Issued by
- Dauphin County, Pennsylvania
About this file
This is an Iran Free Procurement Certification Form (BOP-1701) issued by the Commonwealth of Pennsylvania under the state's Procurement Code Sections 3501-3506, applicable to the contract opportunity for Replacement Plexiglass for Play Stations. The project requires the supply of 15 1/2" W x 6" H plexiglass replacements for Lottery 16" Playstation units, with specifications including rounded edges and two drilled holes positioned approximately one inch from each top edge. Delivery must occur within 40 business days following proof approval, with the supplier required to submit a physical proof to the agency within 7 working days of receiving the Purchase Order or necessary artwork, whichever is later. Packaging must comply with Commonwealth Supplier Shipping & Receiving Guidelines, with individual packages not exceeding 50 pounds and all boxed materials clearly labeled with quantity and description.
Vendors bidding on this contract valued at $1,000,000 or more must complete this certification form to confirm they are not engaged in investment activities in Iran or demonstrate they have received a written exemption from the Pennsylvania Department of General Services. The form requires authorized officer certification under Option #1 or submission of exemption documentation under Option #2. Pennsylvania law imposes significant penalties for false certifications, including civil penalties of $250,000 or twice the contract amount, contract termination, and three-year ineligibility to bid on future Commonwealth contracts.
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| DomesticWorkforceUtilizationCertificationForm_MultipleAward.doc | DOC document | |
| std_9s - 16 in Playstation Plexiglass Replacement.docx | DOCX document | |
| Terms and Conditions for bid 6100066383.pdf | ||
| Worker Protection and Investment Cert Form (BOP 2201).docx | DOCX document | |
| Reciprocal Limitations Act Requirements (GSPUR89).doc | DOC document | |
| Lobbying Certification Form (BOP 1307).doc | DOC document |
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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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