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Bid No. 2019031/1RC-1802 <br />CERTIFICATION REGARDING PROHIBITION AGAINST CONTRACTING WITH <br />SCRUTINIZED COMPANIES <br />(mis form MUST be submittecl with your bid) <br />|hereby certify that neither the undersigned entity, nor any of its whol!y owned subsidiaries, m <br />subsidiaries, parent companies, or affiliates of such entities or business associations, that exists for the purpose <br />of making profit have been placed on the Scrutiriized Conipanies that BoycottIsrael List created pursuant to 5. <br />215.4725 of the Florida Statutes, or are engaged in a boycott of lsrael. <br />In addition, if this solicitation is for a contract for goods or services of one million dollars or more, | hereby <br />certify that neither the unclersigned entity,nor any of its wholty owned subsidiaries, majority-owned <br />subsidiaries, parent companies, or affiliates of such entities or business associations, that exists for the purpose <br />of making profit are on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies <br />with Activities in the Iran Petroleum Energy Sector List, created pursuant to s. 215.473 of the Florida Statutes, or <br />are engaged in business operations in Cuba or Syria as defined in said statute. <br />I understand and agree that the County may immediately terminate any contract resulting from this solicitation <br />upon written notice if the undersigned entity (or any of those related entities of respondent as defined above by <br />Florida law) are found to have submitted a false certification or any of the following occur with respect to the <br />company or a related entity: (i) it has been placed on the Scrutinized Companies that Boycott Israel List, or is <br />engaged in a boycott of Israel, or (ii) for any contract for goods or services of one million dollars or more, it has <br />been placed on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with <br />Activities in the Iran Petroleum Energy Sector List, or it is found to have been engaged in business operations in <br />Cuba or Syria. <br />Dale Bischof f Vero Beach Roof ing Inc . <br />Name "'Respondent: <br />By: <br />(Authorized Signature) <br />Title: Estimator <br />Date: 2/14/I9 <br />Page 21 of 41 <br />