Iran Divestment Act Compliance. PLEASE CHECK ONE: By submission of this Bid, I certify, and in the case of a joint Bid each party thereto certifies as to its own organization, under penalty of perjury, that to the best of my knowledge and belief, that the Bidder is not on the list created pursuant to paragraph (b) of subdivision 3 of Section 165-a of the State Finance Law. I am unable to certify that my name and the Bidder does not appear on the list created pursuant to paragraph (b) of subdivision 3 of Section 165-a of the State Finance Law. I have attached a signed statement setting forth in detail why I cannot so certify. (Signature of Bidder) Print Name: Print Title: Subscribed and sworn to before me this day of , 20 Notary Public Tax ID #: APT E-PIN #: See Footer APT E- Pin # See Footer FMS Project ID#: See Contract Cover Page Response Date See Article 1 Contracting Agency Department of Transportation Agency Address New York City New York State NY Zip Code 10041 Contact Person Xxxxxx Xxxxxx Title Director of M/WBE Program & Oversight Telephone # (000) 000-0000 Email xxxxxxxx@xxx.xxx.xxx Project Description (attach additional pages if necessary)
Iran Divestment Act Compliance. PLEASE CHECK ONE: By submission of this Bid, I certify, and in the case of a joint Bid each party thereto certifies as to its own organization, under penalty of perjury, that to the best of my knowledge and belief, that the Bidder is not on the list created pursuant to paragraph (b) of subdivision 3 of Section 165-a of the State Finance Law. I am unable to certify that my name and the Bidder does not appear on the list created pursuant to paragraph (b) of subdivision 3 of Section 165-a of the State Finance Law. I have attached a signed statement setting forth in detail why I cannot so certify. (Signature of Bidder) Print Name: Print Title: Subscribed and sworn to before me this day of , 20 Notary Public NYCDOT has established the following Disadvantaged Business Enterprise (DBE) utilization goal for this Contract in accordance with §102-12 of the NYSDOT Standard Specifications. This goal is expressed as a percentage of the Total Bid Price. It is the Contractor’s responsibility to secure utilization of the Work, in the Contract, by DBEs in satisfaction of the goal, and to document satisfactory good-faith efforts taken to fulfill the goal. DBE firms must be certified by New York State Department of Transportation Equal Opportunity Development and Compliance (“EODC”) for all items to be performed. Utilization is measured as the amount actually paid to DBEs, not the Total Bid Price for the Work. Disadvantaged Business Enterprise Utilization Goal: See Schedule A % A current listing of certified DBEs is available at xxxx://xxxxxx.xxxxxx.xxx/ or upon written request from: The Bidder shall designate and enter below the name of a Disadvantaged Business Enterprise Officer that will have the responsibility for and is capable of effectively administering and promoting an active Disadvantaged Business Enterprise Program and who must be assigned adequate authority and responsibility to do so. Telephone: (Revised 08/14)
Iran Divestment Act Compliance. PLEASE CHECK ONE: By submission of this Bid, I certify, and in the case of a joint Bid each party thereto certifies as to its own organization, under penalty of perjury, that to the best of my knowledge and belief, that the Bidder is not on the list created pursuant to paragraph (b) of subdivision 3 of Section 165-a of the State Finance Law. I am unable to certify that my name and the Bidder does not appear on the list created pursuant to paragraph (b) of subdivision 3 of Section 165-a of the State Finance Law. I have attached a signed statement setting forth in detail why I cannot so certify. (Signature of Bidder) Print Name: Print Title: Subscribed and sworn to before me this day of , 20 Notary Public
Iran Divestment Act Compliance. Buyer certifies that, as of the date listed below, it is not on the Final Divestment List as created by the State Treasurer pursuant to N.C.G.S. § 147-86.55, et seq.
Iran Divestment Act Compliance. (a) N.C.G.S. 147-86.59 requires that all bids or contracts or renewals with the State of North Carolina, North Carolina local governments, or any other political subdivision of the State of North Carolina have a certification that the Grantee is not on the Final Divestment List as created by the NC State Treasurer pursuant to N.C.G.S. § 147- 86.58. In compliance with the requirements of the Iran Divestment Act 2015 and N.C.G.S. § 147-86.55 and 147-86.59, the Grantee shall not utilize the performance of the contract of any subcontractor that is identified on the Final Divestment List. The State Treasurer’s Final Divestment List can be found on the State Treasurer’s website: xxx.xxxxxxxxxxx.xxx/Xxxx and will be updated every 180 days, effective February 26, 2016.
Iran Divestment Act Compliance. Through the execution of this contract the contractor certifies that they meet the requirements of North Carolina General Statute 143C-6A-1 through 9 - Iran Divestment Act.
Iran Divestment Act Compliance. PLEASE CHECK ONE: By submission of this Bid, I certify, and in the case of a joint Bid each party thereto certifies as to its own organization, under penalty of perjury, that to the best of my knowledge and belief, that the Bidder is not on the list created pursuant to paragraph (b) of subdivision 3 of Section 165-a of the State Finance Law. I am unable to certify that my name and the Bidder does not appear on the list created pursuant to paragraph (b) of subdivision 3 of Section 165-a of the State Finance Law. I have attached a signed statement setting forth in detail why I cannot so certify. (Signature of Bidder) Print Name: Print Title: Subscribed and sworn to before me this day of , 20 Notary Public State of County of ss: On this day of , 20 , before me personally appeared to me known, who being by me duly sworn, did depose and say that he /she resides at , that he/she is the of , the corporation described in and which executed the foregoing instrument; that he/she knows the seal of said corporation; that one of the seals affixed to said instrument is such corporate seal; that it was so affixed by order of the directors of said corporation, and that he/she signed his/her name thereto by like order.
Iran Divestment Act Compliance. PLEASE CHECK ONE: By submission of this Bid, I certify, and in the case of a joint Bid each party thereto certifies as to its own organization, under penalty of perjury, that to the best of my knowledge and belief, that the Bidder is not on the list created pursuant to paragraph (b) of subdivision 3 of Section 165-a of the State Finance Law. I am unable to certify that my name and the Bidder does not appear on the list created pursuant to paragraph (b) of subdivision 3 of Section 165-a of the State Finance Law. I have attached a signed statement setting forth in detail why I cannot so certify. (Signature of Bidder) Print Name: Print Title: Subscribed and sworn to before me this day of , 20 Notary Public MINORITY/WOMEN’S BUSINESS ENTERPRISE PARTICIPATION NEW YORK STATE DEPARTMENT OF TRANSPORTATION (MBE/WBE) UTILIZATION REQUIREMENTS The Department has established the following utilization goal(s) for this contract, expressed as a percentage of the total contract bid amount. For clarification Minority Business Enterprise (MBE) Utilization or Women's Business Enterprise (WBE) Utilization requirements refer to §102-12 M/WBE Utilization of the Standard Specifications. The goal is expressed as a percentage of the total contract bid price. It is the contractor’s responsibility to secure utilization in the work of the contract by MBE/WBEs in satisfaction of the goal, and to document satisfactory good-faith efforts taken to fulfill the goal. MBE and WBE firms must be certified by Empire State Development Corporation.
Iran Divestment Act Compliance. PLEASE CHECK ONE: By submission of this Bid, I certify, and in the case of a joint Bid each party thereto certifies as to its own organization, under penalty of perjury, that to the best of my knowledge and belief, that the Bidder is not on the list created pursuant to paragraph (b) of subdivision 3 of Section 165-a of the State Finance Law. I am unable to certify that my name and the Bidder does not appear on the list created pursuant to paragraph (b) of subdivision 3 of Section 165-a of the State Finance Law. I have attached a signed statement setting forth in detail why I cannot so certify. (Signature of Bidder) Print Name: Print Title: Subscribed and sworn to before me this day of , 20 Notary Public SCHEDULE B – M/WBE Utilization Plan Enter the percentage amount for each category or for an unspecified Goal. Unspecified % Black American % Hispanic American % Asian American % Women % APT E-Pin# See Footer FMS Project ID# See Contract Cover Page Project Title See Footer Agency PIN# See Footer Contracting Agency Department of Transportation Bid/Proposal Response Date See Article 1 Agency Address New York City New York State NY ZIP 10041 Contact Person Xxxxxx Xxxxxx Title Director of M/WBE Program & Oversight Telephone (000) 000-0000 Email xxxxxxxx@xxx.xxx.xxx Project Description (attach additional pages if necessary) See Article 4 Bidder or proposer is required OR is not required to specifically identify the contact information of all M/WBE firms they intend to use as a subcontractor on this contract, including the M/WBE vendor name, address and telephone number in the space provided below in Part 2 Section 4. Total Bid/Proposal Value $ Calculated M/WBE Total Bid/Proposal Value $ Total Revised Participation Goals % Calculated M/WBE
Iran Divestment Act Compliance. Each Party affirms that, as of the date of execution of this SOW, it is not listed on the Iran Divestment Act lists created by the North Carolina State Treasurer pursuant to N.C. G.S. 147-86.58, nor are its subsidiaries or parent companies, if any.
