11-Affidavit of Compliance with Foreign Entity and Human Trafficking.pdf
PDF 625 KB Posted
- Attached to
- Prequalification of Roofing Contractors
- Solicitation number
- RFQ No. 2025-029
- Issued by
- Palm Beach County, Florida
About this file
This is a compliance affidavit form from the Town of Palm Beach Procurement and Contracts Division requiring contractors to certify compliance with Florida's foreign entity laws and anti-human trafficking statutes. The document consists of two separate affidavits that entities must execute under penalty of perjury when contracting with the Town of Palm Beach, with the foreign entity affidavit revised July 21, 2023, and the human trafficking affidavit revised October 25, 2024. The form requires notarization and includes signature blocks for authorized representatives of contracting entities, along with spaces for entity information, dates, and notary acknowledgment.
The affidavit addresses compliance with multiple Florida statutes including sections 287.138, 288.007, 692.201-204, and 787.06, requiring entities to attest they are not owned by or controlled by foreign countries of concern (defined as China, Russia, Iran, North Korea, Cuba, Venezuela, and Syria), do not have controlling interests from such countries, are not organized under their laws, and do not engage in human trafficking or coercion for labor or services. The document includes the complete text of relevant Florida statutes defining foreign countries of concern, human trafficking, coercion, and associated penalties, which can include civil penalties up to twice the contract amount, ineligibility for contracts up to five years, and placement on suspended vendor lists for violations.
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Town of Palm Beach Procurement and Contracts Division
Foreign En�ty [Rev. 7/21/2023] and Human Trafficking [Rev. 10/25/2024]
Affidavit of Compliance with Foreign Entity Laws
The undersigned, on behalf of the entity listed below (“Entity”), hereby attests under penalty of perjury as follows:
1. Entity is not owned by the government of a foreign country of concern as defined in Section 287.138, Florida Statutes. (Source: § 287.138(2)(a), Florida Statutes)
2. The government of a foreign country of concern does not have a controlling interest in Entity. (Source: § 287.138(2)(b), Florida Statutes)
3. Entity is not organized under the laws of, and does not have a principal place of business in, a foreign country of concern. (Source: § 287.138(2)(c), Florida Statutes)
4. Entity is not owned or controlled by the government of a foreign country of concern, as defined in Section 692.201, Florida Statutes. (Source: § 288.007(2), Florida Statutes)
5. Entity is not a partnership, association, corporation, organization, or other combination of persons organized under the laws of or having its principal place of business in a foreign country of concern, as defined in Section 692.201, Florida Statutes, or a subsidiary of such entity. (Source:
§ 288.007(2), Florida Statutes)
6. Entity is not a foreign principal, as defined in Section 692.201, Florida Statutes. (Source:
§ 692.202(5)(a)(1), Florida Statutes)
7. Entity is in compliance with all applicable requirements of Sections 692.202, 692.203, and 692.204, Florida Statutes.
8. (Only applicable if purchasing real property) Entity is not a foreign principal prohibited from purchasing the subject real property. Entity is either (a) not a person or entity described in Section 692.204(1)(a), Florida Statutes, or (b) authorized under Section 692.204(2), Florida Statutes, to purchase the subject property. Entity is in compliance with the requirements of Section 692.204, Florida Statutes. (Source: §§ 692.203(6)(a), 692.204(6)(a), Florida Statutes)
Affidavit of Compliance with Anti-Human Trafficking Laws
In accordance with section 787.06(13), Florida Statutes, the undersigned, on behalf of the entity listed below (“Entity”), hereby attests under penalty of perjury that:
1. The Affiant is an adult resident of the State of Florida.
2. The Entity does not use coercion for labor or services as defined in Section 787.06, Florida Statutes, entitled “Human Trafficking”.
3. I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this affidavit and that the punishment for knowingly making a false statement includes fines and/or imprisonment.
Town of Palm Beach Procurement and Contracts Division
Foreign En�ty [Rev. 7/21/2023] and Human Trafficking [Rev. 10/25/2024]
The undersigned is authorized to execute this affidavit on behalf of Entity.
Date: ____________________, 20___ Signed:
Entity: Name:
Title:
STATE OF
COUNTY OF
The foregoing instrument was acknowledged before me, by means of ☐ physical presence or ☐ online notarization, this ____ day of ______________, 20____, by _______________________________, as ____________________________ for _____________________________________________________, who is personally known to me or who has produced ________________________ as identification.
Notary Public Signature: State of Florida at Large (Seal) Print Name: My commission expires:
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