115-25 Proposal - CPS.pdf

[Prohibited Russia-Belarus Activities & [ran Investment Activities L I Person or Entity Custom Pro deahye Senuic?s Part 1: Certification OMPLETE PART | BY CHECKING QNE OF THE THREE BOXES BELOW Pursuant to law, any person or entity that is a successful bidder or proposer, or otherwise proposes to enter into or renew a contract, for goods or services must complete the certification below prior to contract award to lattest, under penalty of perjury, that neither the person or entity, nor any parent entity, subsidiary, or affiliate, is identified on the Department of Treasury's Russia-Belarus list or Chapter 25 list as a person or| lentity engaging in prohibited activities in Russia, Belarus or Iran. Before a contract for goods or services can lbe amended or extended, a person or entity must certify that neither the person or entity, nor any parent entity, subsidiary, or affiliate, is identified on the Department of Treasury's Russia-Belarus list. Both lists are found! n Treasury’s website at the following web addresses: https://www.nj.gov/treasury/administration/pdf/RussiaBelarusEntityList.pdf Iwww.state.nj.us/treasury/purchase/pdf/Chapter25 List.pdf. |As applicable to the type of contract, the above-referenced lists must be reviewed prior to completing the below certification. JA person or entity unable to make the certification must provide a detailed, accurate, and precise description f the activities of the person or entity, or of a parent entity, subsidiary, or affiliate, engaging in prohibited lactivities in Russia or Belarus and/or investment activities in Iran. The person or entity must cease engaging, in any prohibited activities and provide an updated certification before the contract can be entered into. If a vendor or contractor is found to be in violation of law, action may be taken as appropriate and as may be rovided by law, rule, or contract, including but not limited to imposing sanctions, seeking compliance, recovering damages, declaring the party in default, and seeking debarment or suspension of the party. {CONTRACT AWARDS AND RENEWALS certify, pursuant to law, that neither the person or entity listed above, nor any parent entity, subsidiary, or affiliate appears on the N.J. Department of Treasury’s lists of entities engaged in prohibited activities in Russia or Belarus pursuant to P.L. 2022, c. 3 or in investment activities in

subsidiary, or affiliate appears on the N.J. Department of Treasury’s lists of entities engaged in prohibited activities in Russia or Belarus pursuant to P.L. 2022, c. 3 or in investment activities in Iran pursuant to P.L. 2012, c. 25 ("Chapter 25 List"). I further certify that I am the person listed above, or I am an officer or ‘epresentative of the entity listed above and am authorized to make this certification on its behalf. (Skip Part 2 and sign and complete the Certification below.) 21|Page