287.138_Affidavit.pdf
PDF 182 KB Posted
- Attached to
- Electrical Vehicle Charging Station
- Solicitation number
- 25-072-RFP
- Issued by
- Lee County, Fort Lauderdale City, Florida
About this file
This is an Affidavit of Compliance form required by the City of Fort Myers, Florida, in accordance with Section 287.138 of the Florida Statutes, which addresses contracting restrictions with foreign entities of concern. The affidavit requires vendors to certify under oath that they are not owned by, do not have controlling interests from, and are not organized under the laws of specified foreign countries of concern, including 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, or the Syrian Arab Republic. The form must be completed by an authorized representative of the contracting vendor and notarized before submission.
The affidavit serves as a compliance mechanism to prevent the City of Fort Myers from entering into contracts with foreign entities that would grant access to individuals' personal identifying information. Vendors must execute the document in accordance with Florida Statutes and submit it as part of their proposal for the Electrical Vehicle Charging Station project. The form requires the affiant to provide their name, title, and business name, and must be notarized with the notary's signature and seal before or concurrent with proposal submission. This certification is a mandatory requirement for all vendors seeking to contract with the City of Fort Myers on this project.
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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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