Specifications

STATE OF CALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION
OBS 1502 (09/11)
IRAN CONTRACTING ACT
Bid Number: 6000001312
Per Public Contract Code §§ 2200- 2208, prior to bidding on, submitting a proposal or executing a contract or renewal for a State of
California contract for goods or services of $1,000,000 or more, a vendor must either: a) certify it is not on the current list of persons
engaged in investment activities in Iran created by the California Department of General Services (“DGS”) pursuant to Public Contract
Code § 2203(b) and is not a financial institution extending twenty million dollars ($20,000,000) or more in credit to another person, for
45 days or more, if that other person will use the credit to provide goods or services in the energy sector in Iran and is identified on the
current list of persons engaged in investment activities in Iran created by DGS; or
b) demonstrate it has been exempted from the
certification requirement for that solicitation or contract pursuant to Public Contract Code § 2203(c) or (d).
To comply with this requirement, please insert your company/vendor name and Federal ID Number (if available) and complete one of
the options below. Please note: California law establishes penalties for providing false certifications, including civil penalties equal to
the greater of $250,000 or twice the amount of the contract for which the false certification was made; contract termination; and three-
year ineligibility to bid on contracts. (Public Contract Code § 2205)
OPTION #1 - CERTIFICATION
I, the official named below, certify I am duly authorized to execute this certification on behalf of the vendor/financial institution identified
below, and the vendor/financial institution identified below is not on the current list of persons engaged in investment activities in Iran
created by DGS and is not a financial institution extending twenty million dollars ($20,000,000) or more in credit to another
person/vendor, for 45 days or more, if that other person/vendor will use the credit to provide goods or services in the energy sector in
Iran and is identified on the current list of persons engaged in investment activities in Iran created by DGS.
Vendor Name/Financial Institution (Printed)
Federal ID Number (or n/a)
By (Authorized Signature)
Printed Name and Title of Person Signing
Date Executed
Executed in the County and State of
OPTION #2 – EXCEPTIONS
Pursuant to Public Contract Code § 2203(c) and (d), a public entity may permit a vendor/financial institution engaged in investment
activities in Iran, on a case-by-case basis, to be eligible for, or to bid on, submit a proposal for, or enter into or renew, a contract for
goods and services.
If you have obtained an exemption from the certification requirement under the Iran Contracting Act, please fill out the information
below, and attach documentation demonstrating the exemption approval.
Vendor Name/Financial Institution (Printed)
Federal ID Number (or n/a)
By (Authorized Signature)
Printed Name and Title of Person Signing
Date Executed
Executed in the County and State of
Bid 6000001312
State of California
11/14/2013 2:35 PM
p. 134