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Van Fleet Water Production Facility Improvements <br /> BVP 13-196 <br /> EXHIBIT 19 <br /> CERTIFICATION <br /> (Florida Statutes, Section 287.135) <br /> SOLICITATION NO.: BVP 13-196 <br /> PROJECT NAME: Van Fleet Water Production Facility Improvements <br /> of (the <br /> The undersigned, as political <br /> "Contractor"), a Florida corporation,hereby certifies the following to Polk County, a p <br /> subdivision of the State of Florida,by and on behalf of the Contractor in accordance with the <br /> requirements of Florida Statutes, Section 287.135: <br /> (i) the Contractor is not on the Scrutinized Companies with Activities in Sudan <br /> List; and <br /> (ii) the Contractor is not on the Scrutinized Companies with Activities in the Iran <br /> Petroleum Energy Sector List <br /> (as both such lists are created pursuant to Florida Statutes, Section 215.473); and <br /> (iii) the Contractor does not have business <br /> ooperations <br /> t nds (as that term is defined in <br /> Florida Statutes, Section 287.135) in Cuba oSyria; <br /> (iv) the Contractor was not on either of the oregoing lists or bid to the County;conducting business <br /> operations in Cuba or Syria when it submitted <br /> itsand <br /> (v) the Contractor is fully aware of the <br /> penalties <br /> the County regardring the foregoing upon <br /> matters; <br /> Contractor for submitting a false certification to <br /> matters; and <br /> (vi) the undersigned is duly authorized to execute this Certification by and on <br /> behalf of the Consultant. <br /> , <br /> Executed this day of 201_. <br /> ATTEST: Contractor <br /> By: <br /> By PRINTED NAME: <br /> PRINTED NAME: <br /> ItS: <br /> Its: <br /> 104 <br /> 172 - � a� <br />