Document Text
--- Document: Iran Investment Disclosure Statements Document ---
PHILIP D. MURPHY
Governor
SHEILA Y. OLIVER
Lt. Governor
FAL OF THE STATE OF
JERSEY
State of New Jersey
DEPARTMENT OF THE TREASURY
DIVISION OF PURCHASE AND PROPERTY
OFFICE OF THE DIRECTOR
33 WEST STATE STREET
P. O. Box 039
TRENTON, NEW JERSEY 08625-0039
https://www.njstart.gov
Telephone (609) 292-4886 / Facsimile (609) 984-2575
ELIZABETH MAHER MUOIO
State Treasurer
MAURICE A. GRIFFIN
Acting Director
The following list represents entities determined, based on credible information available to the public,
to be engaged in prohibited activities in Iran pursuant to P.L. 2012, c. 25 ("Chapter 25"):
1. AK Makina Ltd.
2. Amona
3. Bank Markazi Iran (Central Bank of Iran)
4. Bank Mellat
5. Bank Melli Iran
6. Bank Saderat PLC
7. Bank Sepah
8. Bank Tejarat
9. China International United Petroleum & Chemicals Co., Ltd. (Unipec)
10. China National Offshore Oil Corporation (CNOOC)
11. China National Petroleum Corporation (CNPC)
12. China National United Oil Corporation (ChinaOil)
13. China Oilfield Services Limited
14. China Petroleum & Chemical Corporation (Sinopec)
15. China Precision Machinery Import-Export Corp. (CPMIEC)
16. Indian Oil Corporation
17. Kingdream PLC
18. Naftiran Intertrade Company (NICO)
19. National Iranian Tanker Company (NITC)
20. Oil and Natural Gas Corporation (ONGC)
21. Oil India Limited
22. Persia International Bank
23. Petroleos de Venezuela (PDVSA Petróleo, SA)
24. PetroChina Company, Ltd.
25. Sameh Afzar Tajak Co. (SATCO)
26. Shandong Fin Cnc Machine Company, Ltd.
27. Sinohydro Co., Ltd.
28. SK Energy Co. Ltd.
29. SKS Ventures
30. Som Petrol AS
31. Zhuhai Zhenrong Company
List Date: January 4, 2021
TOWNSHIP OF BARNEGAT
DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN
PART 1: CERTIFICATION
BIDDERS MUST COMPLETE PART 1 BY CHECKING EITHER BOX.
FAILURE TO CHECK ONE OF THE BOXES MAY RENDER THE PROPOSAL NON-RESPONSIVE.
Pursuant to Public Law 2012, c. 25, any person or entity that submits a bid or proposal or otherwise proposes to enter into or renew a
contract must complete the certification below to attest, under penalty of perjury, that neither the person or entity, nor any of its
parents, subsidiaries, or affiliates, is identified on the Department of Treasury's Chapter 25 list as a person or entity engaging in
investment activities in Iran. The Chapter 25 list is found on the State of New Jersey, Department of Treasury, Division of Purchase
and Property website at http://www.state.nj.us/treasury/purchase/pdf/Chapter25List.pdf. Bidders must review this list prior to
completing the below certification. Failure to complete the certification may render a bidder's bid proposal non-responsive. If the
Township of Barnegat determines that a person or entity has submitted a false certification concerning its engagement in investment
activities in Iran pursuant to section 4 of P.L. 2012, c.25 (C.52:32-58), the local contracting unit shall report to the New Jersey
Attorney General the name of that person or entity, and the Attorney General shall determine whether to bring a civil action against the
person to collect the penalty prescribed in paragraph (1) of subsection a. of section 5 of P.L. 2012, c.25 (C.52:32-59). The Township of
Barnegat may also report to the municipal attorney or county counsel, as appropriate, the name of that person, together with its
information as to the false certification, and the municipal attorney or county counsel, as appropriate, may determine to bring such civil
action against the person to collect such penalty.
PLEASE CHECK THE APPROPRIATE BOX:
I certify, pursuant to Public Law 2012, c. 25, that neither the bidder listed above nor any of the bidder's parents, subsidiaries, or
affiliates is listed on the N.J. Department of the Treasury's list of entities determined to be engaged in prohibited 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 I am authorized to make this certification on its behalf. I will skip Part 2 and sign and complete the
Certification below.
OR
I am unable to certify as above because the bidder and/or one or more of its parents, subsidiaries, or affiliates is listed on
the Department's Chapter 25 list. I will provide a detailed, accurate and precise description of the activities in Part 2 below
and sign and complete the Certification below. Failure to provide such will result in the proposal being rendered as nonresponsive
and appropriate penalties, fines and/or sanctions will be assessed as provided by law.
PART 2: PLEASE PROVIDE FURTHER INFORMATION RELATED TO INVESTMENT ACTIVITIES IN IRAN You
must provide a detailed, accurate and precise description of the activities of the bidding person/entity, or one of its parents,
subsidiaries or affiliates, engaging in the investment activities in Iran outlined above by completing the boxes below.
PROVIDE INFORMATION RELATIVE TO THE ABOVE QUESTIONS. PLEASE PROVIDE THOROUGH ANSWERS
TO EACH QUESTION. IF YOU NEED TO MAKE ADDITIONAL ENTRIES, ATTACH ADDITIONAL PAGES.
Name
Description of Activities
Relationship to Bidder/Offeror_
of Engagement_
Anticipated Cessation Date_
Bidder/Offeror Contact Name_
Contact Phone Number
Duration
TOWNSHIP OF BARNEGAT
DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN
Certification:
I, being duly sworn upon my oath, hereby represent and state that the foregoing information and any
attachments thereto to the best of my knowledge are true and complete. I attest that I am authorized to
execute this certification on behalf of the above-referenced person or entity. I acknowledge that the
Township of Barnegat is relying on the information contained herein and thereby acknowledge that I am
under a continuing obligation from the date of this certification through the completion of any contracts
with the Township of Barnegat to notify the Township of Barnegat in writing of any changes to
the answers of information contained herein. I acknowledge that I am aware that it is a criminal offense
to make a false statement or misrepresentation in this certification, and if I do so, I recognize that I am
subject to criminal prosecution under the law and that it will also constitute a material breach of my
agreement(s) with the Township of Barnegat and that the Township of Barnegat at its option may
declare any contract(s) resulting from this certification void and unenforceable.
I, being duly sworn upon my oath, hereby represent and state that the foregoing
information and any attachments thereto to the best of my knowledge are true and
complete. I attest that I am authorized to execute this certification on behalf of the
above-referenced person or entity.
Bidder:
Signature:
Print Name:
Title:
Date: