3-AFFIDAVIT OF COMPLIANCE - Denying Doing Business with a Foreign Country of Concern 10.docx.docx
DOCX document 17 KB Posted
- Solicitation number
- ITB-25-00328
- Issued by
- Hillsborough County, Florida
About this file
This is an Affidavit of Compliance form required by Hillsborough County, Florida, related to a contract opportunity for irrigation systems maintenance and repair services for the Parks and Recreation Department. The affidavit must be submitted with any bid or proposal as mandated by Florida Statute 287.138, which became effective January 1, 2024, and applies to companies seeking access to personal identifying information through county contracts. The document requires bidders to affirm under penalty of perjury that their company has no involvement with foreign countries of concern, specifically naming China, Russia, Iran, North Korea, South Korea, Cuba, Venezuela under Nicolas Maduro, and Syria. The underlying contract opportunity involves comprehensive commercial irrigation maintenance and repair services across over 170 parks and 250 sports fields with Bermudagrass, including GPS tracking and marking of controls, repairs to heads, valves, wires, and irrigation systems, with an estimated project budget of $239,333.50.
This affidavit serves as a compliance requirement for the Small Business Enterprise (SBE) set-aside contract opportunity and must be notarized before submission. Bidders must complete sections identifying their authorized representative, company formation details, and entity type, while affirming that their company is not owned by, controlled by, or organized under the laws of any foreign country of concern. The form includes standard notarization requirements with options for physical presence or online notarization, and bidders must provide identification if not personally known to the notary. This compliance measure reflects Florida's legislative efforts to restrict state and local government contracts with entities that may have connections to countries deemed security concerns.
View the file
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| 6-ITB-25-00328 Contract Terms and Conditions (SBE Set-Aside).pdf | ||
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| 2-Insurance Certificate.doc | DOC document |
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Text version
AFFIDAVIT OF COMPLIANCE
DENYING BIDDER’S/OFFEROR’S INVOLVEMENT WITH A FOREIGN COUNTRY OF CONCERN
(Pursuant to Florida Statutes 287.138)
*** THIS AFFIDAVIT MUST BE SUBMITTED WITH BIDDER’S BID/OFFER
(Per Florida Statutes, Section 287.138(4)(a), beginning January 1, 2024, Hillsborough County cannot accept a bid on, a proposal for, or reply to, or enter into a contract with a company/entity which would grant such company/entity access to an individual’s personal identifying information unless the company/entity provides the County with an Affidavit denying the company’s/entity’s involvement with a Foreign Country of Concern.)
______________________________________, being duly sworn deposes and states as follows under penalties of perjury:
(Name of person signing Affidavit)
1. My name is __________________________________________________ (Full Name)
2. I am the ____________________________ of ______________________________________________________ (Job Title – Officer/Authorized Representative) (Company Name)
3. The Company was formed in __________________________________________and is a ____________________ (Country and State) (Type of Entity (e.g., Inc., LLC, etc.)
4. I affirm that I am duly authorized and empowered and have sufficient knowledge to execute and deliver this Affidavit on behalf of the Company stated above.
5. I affirm that I have duly read and understand Florida Statutes Section 287.138 in its entirety and affirm as follows:
** For the purposes of this Affidavit a “Foreign Country of Concern” shall mean the People’s Republic of China, the Russian Federation, the Islamic Republic of Iran, the Democratic People’s Republic of Korea, the Republic of Korea, the Republic of Cuba, the Venezuelan regime of Nicolas Maduro, or the Syrian Arab Republic, including any agency of or any other entity of significant control of such foreign country.
(a) The Company is not owned by the government of a Foreign Country of Concern;
(b) The government of a Foreign Country of Concern has no controlling interest in the Company; and
(c) The Company is not organized under the laws of or does not have its principal place of business in a Foreign Country of Concern.
Under penalties of perjury, I declare that I have read this Affidavit and that the facts stated herein are true:
| __________________________________________ | ||||
| (Signature of Affiant) | ||||
| STATE OF | ) | |||
| COUNTY OF | ) | |||
| The foregoing instrument was acknowledged before me by means of physical presence | ||||
| or online notarization this _____ day of | , 20 | , by_________________________________________. |
(Name of Affiant)
(Signature of Notary Public)
(Print, Type, or Stamp Name of Notary Public) Personally Known OR Produced Identification Type of Identification Produced: ___________________________
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