Iran Free Procurement Certification Form.pdf
PDF 29 KB Posted
- Attached to
- District 5 I-78 Warning Gates
- Solicitation number
- 6100066744
- Issued by
- Lehigh County, Allentown City, Pennsylvania
About this file
This is an Iran Free Procurement Certification Form required by the Commonwealth of Pennsylvania under Sections 3501-3506 of the Procurement Code, applicable to the District 5 I-78 Warning Gates repair and maintenance project in Berks and Lehigh Counties, Pennsylvania. The form applies to vendors seeking contracts valued at $1,000,000 or more with Commonwealth entities. Vendors must comply with one of two options: certify 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 demonstrate receipt of a written exemption from the certification requirement on a case-by-case basis.
Pennsylvania law establishes significant penalties for providing 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. An authorized company official must sign and date the certification form, attesting to the vendor's eligibility to contract with the Commonwealth or providing documentation of an approved exemption. Vendors must insert their legal name and the signatory's printed name and title on the form prior to submission with their bid.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| D5 Warning Gate Location Map Blueprint Drawings.pdf | ||
| Terms and Conditions.pdf | ||
| OS-52.pdf | ||
| Domestic Workforce Utilization Certification Form-Multiple Award (1).doc | DOC document | |
| D5 I-78 Warning Gates SOW.doc | DOC document | |
| OS-501.pdf | ||
| Attachment A - Gate and Guiderail Coordinates.pdf | ||
| Attatchment B - Worker Protection Agency Form BOP-2201.docx | DOCX document | |
| TradeSecret Form.pdf | ||
| Roadside Activity Report (M-609).pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 |
File details come from the government source that posted it. Updated .