287.138_Affidavit.pdf
PDF 182 KB Posted
- Attached to
- Meter Changeout Supplies State and local contract opportunity
- Solicitation number
- 25-046-ITB
- Issued by
- Lee County, Fort Lauderdale City, Florida
About this file
This document is an Affidavit of Compliance with Section 287.138 of Florida Statutes, specifically for the City of Fort Myers, related to contracting with foreign entities of concern. The affidavit requires a vendor to certify that they are not owned by, controlled by, or principally located in certain foreign countries deemed to be of concern, including the People's Republic of China, Russian Federation, Iran, North Korea, Cuba, Venezuela under the Maduro regime, and Syria.
The purpose of this affidavit is to prevent the County from entering contracts with foreign entities that could potentially provide access to an individual's personal identifying information. By executing this document, the vendor affirms they do not have significant connections to the specified foreign countries of concern, as defined by Florida Statutes. The form requires notarization and includes spaces for the vendor's title, business name, signature, and date, along with a notary section to formally attest to the vendor's statements.
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Text version
AFFIDAVIT OF COMPLIANCE WITH SECTION 287.138, FLORIDA STATUTES,
CONTRACTING WITH FOREIGN ENTITIES OF CONCERN
Before me, the undersigned authority, personally appeared (Name of affiant)
______________________________________________, who, after being first duly sworn, deposes and says of his or her personal knowledge the following:
1. Affiant is the (Title) ________________________________________________ of (Business Name)
_____________________________________________________________________________ which does business in the State of Florida, hereinafter called the “Vendor.”
2. Vendor, pursuant to Section 287.138, Florida Statues, certifies that (1) Vendor is not owned by a government of a foreign country of concern; (2) a government of a foreign country of concern does not have a “controlling interest” in Vendor, as defined by Section 287.138(1)(a), Florida Statutes; and (3) Vendor is not organized under the law of nor has its principal place of business in a foreign country of concern. For the purposes of this affidavit, 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, as defined in Section 287.138(1)(c), Florida Statutes.
3. This Affidavit is executed by the Vendor accordance with Section 287.138, Florida Statutes, for the purposes of preventing the County from entering contracts with foreign entities of concern which would provide
Vendor access to an individual’s personal identifying information.
Signed and Delivered on this day of _______________, 202__.
BY: ___________________________________
Signature of Affiant
Printed Name
STATE OF FLORIDA
COUNTY OF __________
Sworn to (or affirmed) and subscribed before me by means of physical presence or online notarization, this ____ day of ___________________, 20____, by ______________________________.
Personally Known OR Produced Identification Type of Identification Produced ____________ ______________________________
(Notary Signature)
(SEAL)
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