1-G. Use of Companies owned or Controlled by a Foreign Country of Concern Affidavit for Nongovernmental Entities.pdf
PDF 486 KB Posted
- Attached to
- Yearbook Services - RFQ #26-0004
- Solicitation number
- 26-0004
- Issued by
- Sarasota County, Florida
About this file
This is an affidavit form (Attachment G) for The School Board of Sarasota County, Florida's solicitation #26-0004 for Yearbook Services. The document is required under Section 287.138 of Florida Statutes and must be completed by vendors to certify that they are not owned or controlled by a foreign country of concern as defined by state law. The form requires vendors to provide company information including name, FEIN, authorized representative details, and contact information, then certify under penalty of perjury that the company meets compliance requirements.
The affidavit specifically addresses restrictions on contracting with companies owned or controlled by foreign countries of concern, which include the People's Republic of China, Russian Federation, Islamic Republic of Iran, Democratic People's Republic of Korea, Republic of Cuba, Venezuelan regime of Nicolás Maduro, or Syrian Arab Republic. Vendors must certify that they are not owned by these governments, that these governments do not have controlling interest in their company, and that the company is not organized under the laws of or has its principal place of business in these countries. The form requires notarization and an authorized signature from a company representative to complete the compliance certification process.
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Text version
#30889369v1
State of Florida Affidavit Regarding the Use of Companies Owned or Controlled by a Foreign Country of Concern
Respondent Vendor Name:
Vendor FEIN:
Vendor's Authorized Representative Name and Title: ___________________________________
Address: ______________________________________________________________________
City: ____________________________ State: ______________ ZIP: _____________________
Phone Number: _____________________________________________
Email Address:
Section 287.138, Florida Statutes prohibits governmental entities from entering into contracts with companies owned or controlled by a foreign country of concern, meaning the People’s Republic of China, the Russian Federation, the Islamic Republic of Iran, the Democratic People’s Republic of Korea, the Republic of Cuba, the Venezuelan regime of Nicolás Maduro, or the Syrian Arab Republic, including any agency of or any other entity of significant control of such foreign country of concern. It requires all nongovernmental entities executing, renewing, or extending a contract with a governmental entity to provide an affidavit signed by an officer or representative of the nongovernmental entity under penalty of perjury that the nongovernmental entity is not owned or controlled by a foreign country of concern. The School Board of Sarasota County is a governmental entity for purposes of this statute.
As the person authorized to sign on behalf of Respondent, I certify that the company identified:
• Is not owned by the government of a foreign country of concern.
• The government of a foreign country of concern does not have controlling interest in the company.
• The company is not organized under the laws of or has its principal place of business in a foreign country of concern.
Under penalties of perjury, I declare that I have read the foregoing document and that the facts stated in it are true.
By: __________________________________________________________________________
AUTHORIZED SIGNATURE
Print Name and Title: ____________________________________ Date: ___________________
STATE OF ________________
COUNTY OF ______________
The foregoing instrument was acknowledged before me by means of ☐ physical presence or ☐ online notarization this ______ day of ______________, 202_, by ____________________________________, who is personally known ___ or produced ___________________________ as Identification.
Notary Public Print Name:
My Commission Expires: ___________
THE SCHOOL BOARD OF SARASOTA COUNTY, FLORIDA
YEARBOOK SERVICES - #26-0004
ATTACHMENT G
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