3-G. Use of Companies owned or Controlled by a Foreign Country of Concern Affidavit for Nongovernmental Entities.pdf

#30889369v1

Respondent Vendor Name:

Vendor FEIN:

Vendor's Authorized Representative Name and Title: ___________________________________

Address: ______________________________________________________________________

City: ____________________________ State: ______________ ZIP: _____________________

Phone Number: _____________________________________________

Email Address:

Section 287.138, Florida Statutes prohibits governmental entities from entering into contracts with companies owned or controlled by a foreign country of concern, meaning 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. It requires all nongovernmental entities executing, renewing, or extending a contract with a governmental entity to provide an affidavit signed by an officer or representative of the nongovernmental entity under penalty of perjury that the nongovernmental entity is not owned or controlled by a foreign country of concern. The School Board of Sarasota County is a governmental entity for purposes of this statute.

As the person authorized to sign on behalf of Respondent, I certify that the company identified:

• Is not owned by the government of a foreign country of concern.

• The government of a foreign country of concern does not have controlling interest in the company.

• The company is not organized under the laws of or has its principal place of business in a foreign country of concern.

Under penalties of perjury, I declare that I have read the foregoing document and that the facts stated in it are true.

By: __________________________________________________________________________

AUTHORIZED SIGNATURE

Print Name and Title: ____________________________________ Date: ___________________

STATE OF ________________

COUNTY OF ______________

The foregoing instrument was acknowledged before me by means of ☐ physical presence or ☐ online notarization this ______ day of ______________, 202_, by ____________________________________, who is personally known ___ or produced ___________________________ as Identification.

Notary Public Print Name:

My Commission Expires: ___________

THE SCHOOL BOARD OF SARASOTA COUNTY, FLORIDA

HVAC – VARIABLE FREQUENCY DRIVE – MATERIALS & REPAIR SERVICES – BID #26-0111

ATTACHMENT G

State of Florida

Affidavit Regarding the Use of Companies Owned or Controlled by a Foreign Country of Concern