ITB202608_CDBG_Infrastructure_Improvement_Project__Exhibit_J.pdf
PDF 154 KB Posted
- Attached to
- Infrastructure Improvement Project
- Solicitation number
- ITB-2026-08 CDBG
- Issued by
- Santa Rosa County, Florida
About this file
This document is a Scrutinized Companies Certification form for the City of Milton, Florida's CDBG Infrastructure Improvement Project (ITB-2026-08). Contractors bidding on this project must execute this certification as a material requirement for contract award. The mandatory pre-bid conference and site visit are scheduled for 11:00 A.M. on Tuesday, July 21, 2026, at the City of Milton Council Chambers, 6738 Dixon Street, Milton, FL 32570.
By executing this certification, the contractor attests under penalty of perjury that it is not listed on any scrutinized companies list maintained pursuant to Florida Statutes 287.135, including lists related to Sudan activities, Iran petroleum energy sector activities, or Israel boycotts. Additionally, the contractor certifies that it is not engaged in business operations in Cuba or Syria, is not a foreign principal from a country of concern, and is not owned or controlled by such a foreign principal as defined in Florida Statutes 286.101 and 287.138. Submission of a false certification may result in civil and criminal penalties and contract termination. The contractor must provide authorized signature, printed name, title, and date on the form prior to bid submission.
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Text version
EXHIBIT J – SCRUTINIZED COMPANIES CERTIFICATION
CDGB Infrastructure Improvement Project
Authority: § 287.135, 215.4725, F.S.
Contract No. CDBG-CON-01
The undersigned, being duly authorized to execute this certification on behalf of
____________________________________ (“Contractor”), hereby certifies under penalty of perjury that, as of the date set forth below:
1. Contractor is not listed on any scrutinized companies list maintained pursuant to
§287.135, Fla. Stat., including the Scrutinized Companies with Activities in Sudan List, the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or the Scrutinized Companies that Boycott Israel List.
2. Contractor is not engaged in a boycott of Israel as defined in §215.4725, Fla. Stat.
3. Contractor is not engaged in business operations in Cuba or Syria as prohibited by
§287.135, Fla. Stat.
4. Contractor is not a foreign principal from a foreign country of concern, and is not owned or controlled by a foreign principal from a foreign country of concern, as provided in
§§286.101 and 287.138, Fla. Stat.
5. Contractor acknowledges that this Certification is a material representation of fact upon which the City is relying in entering into or continuing the Agreement.
Contractor acknowledges that submitting a false certification may subject Contractor to civil and criminal penalties and to termination of the Agreement pursuant to § 287.135(3) and (5), Fla.
Stat.
Bidder/Contractor: ___________________________________________
Authorized Signature: ______________________________________________
Printed Name: _____________________________________________________
Title: _____________________________________________
Date: ____________________________________________
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