261-25 Cerbo Submission.pdf

Disclosure of Investment Activities in Iran Person or Entity |-Part 1: Ceitification COMPLETE PART 1 BY. CHECKING EXTHER BOX, Pursuant to Public Law 20 12, ¢. 25, any person of entity that is a successful bidder or proposer, or "otherwise proposes to enter into or renew. a contract, must complete the certification below to attest, “linder penalty of; petjury, that neither the person or entity, nor any parent entity, subsidiary, or affiliate ig identified-on the State Department of Treasury's Chapter 25 list as a person or entity engaging in investment..-activities “in Trani The “fist - is found: on: “Treasury’s:.” website’ ~ at wiv. stale. nj. us/tteasurv/nurehase/ed¢Chaptor2S1 ist pdt 4 The Chapier:25 list must: be reviewed ptior to-completing the below. certification. “If a. vendor or - contractor is found to be in violation of law, action may be taken ‘as appropriate and-as may. provided “by law; ruler contract, incliding but"not limited to iniposing” sanctions, seeking compliance, recovering damages, declaring the party in defaulvand: sealing de debarment ot ‘Suspension of the party. I certify, pursuant to Public Law 2012, ¢. 25, that neither the person or entity listed ahove, nor_any parent entity, subsidiary, or_affiliate thereof is_listed_on_the-N.J— 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 representative of the entity listed above and am authorized to make this certification on its behalf. I will skip Part 2 and sign and complete the Certification below. of Department of the Treasury’s list of entities determined to be engaged in prohibited OR. Lam unable to certify as above because the person or entity and/or a parent entity, subsidiary, or affiliate thereof is listed on the N.J. Department of the oO Treasury's Chapter 25 list. I will provide a detailed, accurate and precise description of the activities in Part 2 below sign and complete the Certification below. 96