20251222151450473 Foreign Countries of Concern Affidavit v. 12.25.pdf
PDF 556 KB Posted
- Attached to
- Advanced Metering Infrastructure Program State and local contract opportunity
- Solicitation number
- 138260
- Issued by
- Polk County, Florida
About this file
This is a compliance affidavit form required by the Central Florida Tourism Oversight District (CFTOD) for the Advanced Metering Infrastructure (AMI) Program solicitation. The form implements Florida Statute 287.138 requirements prohibiting contracting with entities of foreign countries of concern, which are defined as 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 Nicolas Maduro, and the Syrian Arab Republic. All bidders must complete and submit this affidavit with their bid response to the CFTOD Procurement & Contracting Department, PO Box 690519, Orlando, Florida 32869. The affidavit requires the respondent entity to attest under penalty of perjury that it is not owned by, does not have a controlling interest held by, and is not organized under the laws of any foreign country of concern.
The form defines "controlling interest" as direct or indirect possession of the power to direct management or policies of a company, with a presumption of controlling interest at 25 percent or more of voting interests or profits. False statements on the affidavit may result in bid rejection, debarment, and contract termination. The document provides fields for entity name, solicitation/bid identification, date, and authorized representative signature. Completion of this compliance document is mandatory for all entities submitting proposals for the AMI program, which encompasses deployment of a multi-utility metering system, replacement of existing meters, migration of legacy FoxPro data to modern SQL database infrastructure, and establishment of data retention and ownership protocols.
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Text version
Completed form must be submitted with bid response.
Procurement & Contracting Department
PO Box 690519, Orlando, FL 32869
COMPLIANCE WITH §FS 287.138
CONTRACTING WITH ENTITIES OF FOREIGN COUNTRIES OF CONCERN PROHIBITED
DEFINITIONS
“Foreign country of concern” means 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.
“Controlling interest” means possession of the power to direct or cause the direction of the management or policies of a company, whether through ownership of securities, by contract, or otherwise. A person or entity that directly or indirectly has the right to vote 25 percent or more of the voting interests of the company or is entitled to 25 percent or more of its profits is presumed to possess a controlling interest.
ENTITY INFORMATION
(References to “entity” refer to the corporation, Limited Liability Company, sole proprietor or individual submitting a bid/proposal to the Central Florida Tourism Oversight District.)
The entity does not meet any of the criteria below:
(a) The entity is owned by the government of a foreign country of concern;
(b) The government of a foreign country of concern has a controlling interest in the entity; or
(c) The entity is organized under the laws of or has its principal place of business in a foreign country of concern.
RESPONDENT/COMPANY (“ENTITY”) AFFIDAVIT
I affirm the entity is not owned by the government of a foreign country of concern; the government of a foreign country of concern does not have a controlling interest in the entity; and the entity is not organized under the laws of or has its principal place of business in a foreign country of concern.
I attest under the penalty of perjury that the entity does not meet any of the criteria in paragraphs (a)-(c) above and understand that a false statement may result in bid rejection, debarment and contract termination.
ENTITY NAME: ____________________________________________________________________________________________
Solicitation/Bid: _________________________________________________________ Date: ___________________________
Officer/Authorized Representative Signature: ____________________________________________________________
v. 12.25 http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0200-0299/0287/Sections/0287.138.html
| ENTITY NAME: |
| SolicitationBid: |
| Check Box1: Off |
| Date: |
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