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04 SJ'ANY /sR <br />F F <br />_ n <br />U 2 <br />. ° CONTRACTOR ANTI -BOYCOTT CERTIFICATION <br />'DD O <br />P � <br />FLOR °5a <br />[PURSUANT TO FLORIDA STATUTE § 287.1351 <br />on behalf of , <br />Print Name Company Name <br />certifies that <br />Company Name <br />1. Participate in a boycott of Israel; and <br />does not: <br />2. Is not on the Scrutinized Companies that Boycott Israel list; and <br />3. Is not on the Scrutinized Companies with Activities in Sudan List; and <br />4. Is not on the Scrutinized Companies with Activities in the Iran Petroleum <br />Energy Sector List; and <br />5. Has not engaged in business operations in Cuba or Syria. <br />Signature <br />Title <br />Date <br />