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 for a copy machine Request for Proposals issued by Melvindale-Northern Allen Park Public Schools. The procurement involves the purchase of three copy machines, with two units designated for Allendale and one unit for Strong. All bids submitted in response to this RFP must be accompanied by a sworn statement disclosing any Iran Linked Business relationships existing within the bidder's ownership structure, including its officers, directors, and employees. The affidavit requires the bidder to certify under Michigan Public Act No. 517 of 2012 that neither the bidder nor its officers, directors, and employees constitute an "Iran Linked Business" and that the bidder will not become an Iran Linked Business during contract performance.
Bidders who submit false certifications face significant penalties, including civil liability of up to $250,000 or twice the contract amount, whichever is greater, plus investigation costs and reasonable attorney fees. Additionally, any person found to have submitted a false certification will be ineligible to bid on future District RFPs for three years from the date of determination. The affidavit must be notarized and signed by an authorized representative of the bidding company, with the notary public's signature, commission expiration date, and county of service required on the form.
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Other files
| File | Type | Posted |
|---|---|---|
| Familial Relationship disclosure.doc | DOC document | |
| RFP for Copy Machines.docx | DOCX 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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