SELF CERTIFICATION of AntiMafia communication and information EN version.docx
DOCX document 26 KB Posted
- Attached to
- PROCUREMENT AND DISPOSAL OF FIRE EXTINGUISHERS
- Solicitation number
- N6817126QN083
About this file
This file is a self-certification template for anti-mafia compliance required under Italian Legislative Decree 06/09/2011 n.159. The document contains two separate certification forms that prospective contractors must complete and submit as part of the procurement process for fire extinguishers and disposal services at Naval Support Activity (NSA) Naples Fire & Emergency Services.
The first certification form requires the contractor to declare under criminal liability that they are not subject to causes of prohibition, forfeiture, or suspension pursuant to Article 57 of Legislative Decree 159/2011. The second certification form extends this declaration to include the contractor and all cohabiting family members aged 18 or older, requiring their names, dates of birth, places of birth, and fiscal codes. Both forms must be signed and accompanied by a copy of the signatory's identity document. The certifications serve as self-attested statements replacing traditional public administration certifications and confirm compliance with Italian anti-mafia regulations and data protection requirements under Legislative Decree 196/2003. These certifications do not require notarization and are specifically designed for use in Italian government procurement procedures, though their relevance to the U.S. Navy contract for fire extinguisher procurement at NSA Naples suggests this solicitation may involve international compliance requirements or Italian regulatory adherence for operations in Italy.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 4.02d Solicitation Amendment N6817126QN0830002 SF 30.pdf | ||
| SELF CERTIFICATION of AntiMafia communication and information EN version.docx | DOCX document | |
| 4.02a Solicitation Amendment N6817126QN0830001 SF 30.pdf | ||
| Solicitation - N6817126QN083.pdf | ||
| ELINS MATRIX- Final.xlsx | XLSX spreadsheet |
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
SELF-CERTIFICATION OF THE ANTI-MAFIA COMMUNICATION
(Art. 85 of Legislative Decree 06/09/2011 n.159)
The undersigned (Last name, Name) ______________________________________________________________
| Date and place of Birth | FISCAL CODE or VAT Number | Place of residence | Prov. | |
| Street_____________________________________________________________________ | n•_____________ |
Fully aware of the criminal liability faced, pursuant to and by effect of articles 75 and 76 of the Presidential Decree 28 December 2000, n• 445, in case of false declarations or creation, exhibition or use of false documents, or documents containing data no longer corresponding to the truth, declares and attests under his/her own responsibility:
That the causes of prohibition, forfeiture or suspension pursuant to art. 57 of Legislative Decree 06/09/2011 n• 159 are not present.
The undersigned also declares to be fully informed, pursuant to Legislative Decree No. 196/2003 (Code regarding the protection of personal data), that the data collected will be processed, even with IT tools, exclusively within the purpose of the procedure for which this declaration is made.
Date
Signature
Provide copy of the Identity document of the subscriber.
This declaration does not require the authentication of the signature and replaces, for all the intents and purposes, the normal certifications required by a Public Administration, as well as for managers of public services and the private sector who allow it.
Legislative Decree 06/09/2011 n. 159, art. 85 https://def.finanze.it/DocTribFrontend/decodeurn?urn=urn:doctrib::DLG:2011-09-06;159_art85
Attachment 1
SELF-CERTIFICATION OF THE ANTI-MAFIA INFORMATION
(Art. 85 of Legislative Decree 06/09/2011 n.159)
The undersigned (Last name, Name) ______________________________________________________________
| Date and place of Birth | FISCAL CODE or VAT Number | Place of residence | Prov. | |
| Street_____________________________________________________________________ | n•_____________ |
Fully aware of the criminal liability faced, pursuant to and by effect of articles 75 and 76 of the Presidential Decree 445 of 28 December 2000, in the event of false declarations or the formation, exhibition or use of false documents, or documents containing data that no longer correspond to the truth, declares and attests under his/her own responsibility:
That are no causes of prohibition, forfeiture or suspension pursuant to art. 67 of Legislative Decree 06/09/2011 No. 159, for the undersigned and/or cohabiting family members aged 18 or more (whose data are made available below).
| FIRST NAME |
| LAST NAME |
| Date of Birth |
| Place of Birth |
| Fiscal Code |
The undersigned also declares to be fully informed, pursuant to Legislative Decree No. 196/2003 (Code regarding the protection of personal data), that the data collected will be processed, even with IT tools, exclusively within the purpose of the procedure for which this declaration is made.
Date
Signature
Provide copy of the Identity document of the subscriber.
This declaration does not require the authentication of the signature and replaces, for all the intents and purposes, the normal certifications required by a Public Administration, as well as for managers of public services and the private sector who allow it.
Legislative Decree 06/09/2011 n. 159, art. 85 https://def.finanze.it/DocTribFrontend/decodeurn?urn=urn:doctrib::DLG:2011-09-06;159_art85
Attachment 2
File details come from the government source that posted it. Updated .