17-Affidavit of Compliance with Foreign Entity and Human Trafficking.pdf
PDF 625 KB Posted
- Attached to
- Police Station Improvements
- Solicitation number
- ITB No. 2026-010
- Issued by
- Palm Beach County, Florida
About this file
This is an Affidavit of Compliance form required by the Town of Palm Beach, Florida Procurement and Contracts Division for the Police Station Improvements project. The affidavit serves as a prerequisite compliance document that contractors must execute and notarize before submitting bids for the project. The document requires the bidding entity to attest under penalty of perjury to compliance with Florida foreign entity laws and anti-human trafficking statutes. Specifically, contractors must confirm they are not owned or controlled by foreign governments designated as countries of concern, are not organized under foreign laws with a principal place of business abroad, and do not meet the definition of a foreign principal as defined under Florida Statutes Sections 287.138, 288.007, and 692.201-692.204. Additionally, for projects involving real property purchases, contractors must certify they are not prohibited foreign principals under applicable law.
The second compliance requirement mandates that contractors attest they are adult Florida residents and that their entity does not use coercion for labor or services as defined under Florida's human trafficking statutes (Section 787.06). The affiant must understand that false statements carry penalties including fines and imprisonment. The form requires execution by an authorized representative of the bidding entity, with signatures from both the contractor and a notary public who must acknowledge the affiant by physical presence or online notarization. The document provides blank fields for the date, entity name, title of authorized signatory, county location, and notary information. This affidavit must be completed and submitted as part of the competitive bidding process for the Police Station Improvements renovation and expansion project.
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Text version
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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