W912PF25QPOLS_Attachment10_Self Certification for Antimafia Communication.pdf

234 KB Posted

Attached to
Maintenance and Cleaning of Petroleum Oil Lubricants Separators (POL), Grease Traps, Lift Stations, Water Holding Tanks and Fuel Tanks at USAG Italy DMC
Solicitation number
W912PF25QPOLS
Issued by

About this file

Written by GovTribe AI ·

This document is a self-certification form for Antimafia communication, part of Attachment 10 for the Combined Synopsis Solicitation W912PF25QPOLS. The form is a standard Italian legal declaration (D.P.R. n. 445 del 28.12.2000) that requires an individual representing a company to declare that they are not subject to restrictions or disqualifications under Article 67 of Legislative Decree 159 from 06/09/2011. The form provides space for the declarant to input personal details such as name, tax code, birthplace, residence, company position, and company information, and includes a privacy statement acknowledging data collection under Legislative Decree 196/2003.

View the file

Other files

File Type Posted
B08-Amendment 0001_Combined Synopsis Solicitation W912PF25QPOLS_20250812.docx DOCX document
W912PF25QPOLS_Attachment8_List Fuel Storage Tanks of Generators.pdf PDF
W912PF25QPOLS_Attachment5_Piano di Primo Intervento Aggiornamento_Ott20 (It).pdf PDF
W912PF25QPOLS_Attachment3_Hazards General List (Engl_It).pdf PDF
W912PF25QPOLS_Attachment7_List Fuel Storage Tanks.pdf PDF
W912PF25QPOLS_Attachment9_ Experience Questionnaire.pdf PDF
W912PF25QPOLS_Attachment4_First Aid Plan Review_Oct20 (Engl).pdf PDF
W912PF25QPOLS_Attachment1_Pricing Worksheet Maintenance and Cleaning of POLs.xlsx XLSX spreadsheet
W912PF25QPOLS_Attachment2_Performance Work Statement.pdf PDF
Combined Synopsis Solicitation W912PF25QPOLS_20250722.docx DOCX document
W912PF25QPOLS_Attachment6_DUVRI_signed.pdf PDF
Show all 11

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file
Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

POLS

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 .