Attach9SelfCertificationforAntimafiaCommunication.pdf

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Custodial Services at DMC-USAG Italy
Solicitation number
W912PF19Q0045
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This document is a self-certification form for antimafia communication regarding a company's eligibility for a contract opportunity. The form requires a representative of the bidding company to declare that they are not subject to any prohibitions, decertification, or suspension under Article 67 of Legislative Decree no. 159 of September 6, 2011. The representative must also acknowledge being informed that any personal data collected will be processed, including with IT tools, exclusively for the procedure for which this declaration is made.

The related federal contract opportunity is solicitation number W912PF19Q0045 for custodial services at the DMC-USAG Italy. The solicitation does not provide additional details on the required services, response dates, or award timing. The contracting agency is listed as the Department of the Army Materiel Command Army Contracting Command.

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Self-certification for Antimafia communication

Autocertificazione della comunicazione antimafia

Dichiarazione sostitutiva di certificazione (D.P.R. n. 445 del 28.12.2000)

Il/la sottoscritto/a (nome e cognome) _______________________________ C.F._________________ nato/a _______________________________ Prov. _________ il ______________ residente a

________________________ Prov. _____ in via/piazza ____________________

_______________________________ n. ____, in qualità di (carica ricoperta) ___________ dell’impresa (indicare la denominazione) _______________________________________________ C.F. __________________ avente la sede in _________________________ Prov. di __________ Via ___________________________ n. ______ consapevole delle sanzioni penali in caso di dichiarazioni false e della conseguente decadenza dai benefici eventualmente conseguiti (ai sensi degli artt. 75 e 76 D.P.R. 445/2000) sotto la propria responsabilità

DICHIARA

che nei propri confronti non sussistono le cause di divieto, di decadenza o di sospensione di cui all’art. 67 del D.lgs. n. 159 del 06/09/2011.

Il/la sottoscritto/a dichiara inoltre di essere informato/a, ai sensi del D.Lgs. n. 196/2003 (codice in materia di protezione di dati personali) che i dati personali raccolti saranno trattati, anche con strumenti informatici, esclusivamente nell’ambito del procedimento per il quale la presente dichiarazione viene resa.

data firma leggibile del dichiarante (2)

File details come from the government source that posted it. Updated .