3-AFFIDAVIT OF COMPLIANCE - Denying Doing Business with a Foreign Country of Concern 10.docx.docx
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- Solicitation number
- RPS-25-00264
- Issued by
- Hillsborough County, Florida
About this file
This document is an Affidavit of Compliance required by Hillsborough County, Florida, specifically addressing a requirement for bidders to declare their non-involvement with designated foreign countries of concern. The affidavit is part of a solicitation for Professional and Miscellaneous Services for Geomatics, where the Hillsborough County Performance, Data, and Analytics department is seeking competitive sealed proposals from qualified Geomatic professionals. The project involves survey and mapping, geographic information systems, and asset inventory services for various county projects, with a four-year contract term and a total project estimate of $3,200,000.
The solicitation includes a Disadvantaged Minority/Disadvantaged Women Business Enterprise (DM/DWBE) Participation Goal of 10%. Bidders must complete this affidavit, which requires them to affirm that they are not owned by, do not have a controlling interest from, and are not principally based in countries designated as "Foreign Countries of Concern" - which include China, Russia, Iran, North Korea, Cuba, Venezuela, and Syria. The affidavit must be submitted with the bid/proposal, and firms must be licensed in the State of Florida as a Professional Surveyor and Mapper business. Subcontracting among firms is permitted to develop an optimal team approach.
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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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