W912PF26RA001_Attachment-5_Self-Certification-for-Anti-mafia.docx

This is an Anti-Mafia Self-Certification form required for the USAG Italy Security Guards contract solicitation (W912PF26RA001). The document is a declaration substitute for certification under Italian law (D.P.R. n. 445 of December 28, 2000) that must be completed and signed by the authorized representative of a bidding contractor or subcontractor.

The form requires the declarant to certify under penalty of perjury that neither they nor their organization is subject to the prohibitions, disqualifications, or suspensions outlined in Article 67 of Italian Legislative Decree No. 159 of September 6, 2011 (anti-mafia regulations). The signatory must provide personal identification information including name, tax identification number, birthplace, residence, title/position, company name, company tax identification number, and company address. The declaration also includes a notice that personal data collected will be processed exclusively for the contracting procedure in accordance with Italian data protection law (D.Lgs. n. 196/2003). This certification document is a compliance requirement for contractors bidding on U.S. Army security services at installations in Italy and must be signed and dated by an authorized representative of the bidding organization.