287.138_Affidavit.pdf
PDF 182 KB Posted
- Attached to
- Material Testing Services Continuing Contract
- Solicitation number
- 25-054-RSQ
- Issued by
- Lee County, Fort Lauderdale City, Florida
About this file
This is an Affidavit of Compliance form required by Florida Statutes Section 287.138, applicable to state and local contracting within Florida. The document serves as a certification mechanism to ensure vendors comply with restrictions on contracting with foreign entities of concern. Vendors executing this affidavit must certify three key compliance points: (1) the vendor is not owned by a government of a foreign country of concern; (2) no foreign country of concern government maintains controlling interest in the vendor as defined by statute; and (3) the vendor is not organized under the laws of or headquartered in a foreign country of concern. For purposes of this affidavit, foreign countries of concern are specifically identified 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, including any agencies or entities of significant control thereof.
The affidavit requires execution by an authorized representative of the vendor under oath before a notary public, with the document designed to prevent counties from entering into contracts with foreign entities of concern that would provide access to individuals' personal identifying information. The form includes blank fields for the affiant's name and title, business name, execution date, notary information, and identification verification. This compliance certification is a prerequisite for vendors seeking to do business with Florida state and local government entities and must be completed and notarized prior to contract award.
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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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