B08-SOL_W912PF27QA006_Attachment5_Self CertificationforAntimafiaCommunication.pdf

This document is an Italian anti-mafia self-certification form (Autocertificazione della comunicazione antimafia) required as Attachment 5 for federal contract opportunity W912PF27QA006. The form is a declaration in substitution of certification under Italian Presidential Decree (D.P.R.) n. 445 dated December 28, 2000.

The declarant—identified by name, tax identification number (C.F.), birthplace, province, and residential address—must complete fields indicating their position within the enterprise and the enterprise's name, tax identification number, and registered address. The signatory declares under penalty of perjury that neither they nor their organization are subject to prohibitions, disqualifications, or suspensions outlined in Article 67 of Italian Legislative Decree (D.lgs.) n. 159 dated September 6, 2011. The form further notifies the declarant that personal data collected will be processed exclusively within the scope of the procurement procedure, in compliance with Italian data protection legislation (D.Lgs. n. 196/2003). The form requires completion with the date and a legible signature from the declarant.