14-Affidavit of Compliance with Foreign Entity and Human Trafficking.pdf
PDF 625 KB Posted
- Attached to
- Impact and Mobility Fee
- Solicitation number
- RFP No. 2026-003
- Issued by
- Palm Beach County, Florida
About this file
This is an Affidavit of Compliance document required by the Town of Palm Beach, Florida for the Impact and Mobility Fee consulting services solicitation. The affidavit serves as a mandatory compliance attestation that prospective vendors must execute and notarize to demonstrate eligibility for contract consideration. Respondents must certify compliance with Florida foreign entity laws under Sections 287.138, 288.007, and 692.201-692.204 of the Florida Statutes, affirming that their entity is not owned by, controlled by, or organized under the laws of a foreign country of concern, and is not a foreign principal as defined by state statute. For proposals involving real property purchases, vendors must additionally certify that they are not prohibited foreign principals under Section 692.204. The document requires the affiant to be an adult resident of Florida and to execute the attestation under penalty of perjury before a notary public.
The affidavit also includes a separate anti-human trafficking compliance attestation, requiring vendors to certify under oath that their entity does not use coercion for labor or services as defined in Section 787.06 of the Florida Statutes. The undersigned must acknowledge understanding that false statements in the affidavit carry penalties including fines and imprisonment. The document must be executed by an authorized representative of the responding entity and notarized before submission as part of the vendor's proposal package. This compliance documentation is a prerequisite requirement for all proposers seeking award of the Town's impact and mobility fee consulting services contract.
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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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