Iran Linked Business Disclosure for copy machine rfp.pdf
PDF 208 KB Posted
- Attached to
- RFP for Copy Machines
- Solicitation number
- RFP-MNA-200000000082-2
- Issued by
- Wayne County, Michigan
About this file
This is an Iran Linked Business Affidavit form required by Melvindale-Northern Allen Park Public Schools as part of their bid for Copy Machines (2 machines at Allendale and 1 at Strong). The affidavit, dated October 16, 2019, is mandated under Michigan Public Act No. 517 of 2012 and requires bidders to disclose any Iran Linked Business relationships within their organization, including officers, directors, and employees.
The document outlines penalties for false certification, including civil penalties of up to $250,000 or 2 times the contract amount (whichever is greater), plus investigation costs and attorney fees. Additionally, any person submitting false certification will be ineligible to bid on future RFPs for three years. The form requires notarization and includes a checkbox for bidders to affirm they do not have any Iran Linked Business relationships.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| RFP for Copy Machines.docx | DOCX document | |
| Familial Relationship disclosure.doc | DOC document |
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Text version
10/16/2019 1 of 1
IRAN LINKED BUSINESS AFFIDAVIT
All Bids shall be accompanied by a sworn statement disclosing any Iran Linked Business relationship that exists within the owners, including its officers, directors and employees.
The undersigned, owner or authorized officer of _________________________________ (the bidder), pursuant to Michigan Public Act No. 517 of 2012, the “Iran Linked Business” requirement provided in the
Melvindale-Northern Allen Park Public Schools bid for Copy Machines (2 at Allendale and 1 at Strong), hereby represents and warrants that the bidder, including its officers, directors and employees, is not an
“Iran Linked Business” within the meaning of the applicable Public Act, and that in the event bidder is awarded a contract as a result of this bid, the bidder will not become an “Iran Linked Business” at any time during the course of performing 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 District investigation, and reasonable attorney fees, in addition to the fine. Moreover, any person who submitted a false certification shall be ineligible to bid on future Requests for Proposals (RFPs) for three (3) years from the date that it is determined that the person has submitted the false certification.
There is not an “Iran Linked Business” that exists within the bidder and/or owner, officers, directors and employees.
Bidder: ____________________________________________________________ (Company Name)
By: ____________________________________________________________
(Signature)
(Title)
This instrument was acknowledged before me, a Notary Public, in and for
______________________ County, on this _____day of ___________________, 20__, ______________________________________________ SS:
(Notary Public Signature)
My Commission expires: __________________________
Acting in the County of: __________________________
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