5-AFFIDAVIT OF COMPLIANCE - Denying Doing Business with a Foreign Country of Concern 02.26.2026.docx
DOCX document 17 KB Posted
- Solicitation number
- RFP-26-00156
- Issued by
- Hillsborough County, Madeira Beach City, Florida
About this file
This is an Affidavit of Compliance form required by Hillsborough County, Florida for vendors seeking to provide services on a membrane-based landfill leachate treatment contract valued at $26,600,000.00. The affidavit must be submitted with the bidder's proposal and certifies that the bidding company is not owned by, controlled by, or organized under the laws of a Foreign Country of Concern, as defined by Florida Statutes Section 287.138. The countries specified include 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. The affidavit requires an authorized company representative to swear under penalties of perjury that the company meets these compliance requirements and must be notarized before submission.
The affidavit is a mandatory compliance document effective January 1, 2024, for any company that would receive access to personal identifying information in performing county services. Bidders must complete the form by providing their name, job title, company name, company formation details, and attestation of authorization to execute the document. The notarized affidavit constitutes a prerequisite for bid acceptance on this Hillsborough County landfill leachate treatment project and ensures compliance with Florida's foreign involvement restrictions for county contracts.
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Other files
| File | Type | Posted |
|---|---|---|
| 10-Appendix D.pdf | ||
| 2-Insurance Certificate.doc.doc | DOC document | |
| 7-Appendix B.pdf | ||
| 11-Proposal Bond.docx | DOCX document | |
| 3-Substitute W9 Form.pdf.pdf | ||
| 9-Appendix C.pdf | ||
| 13-RFP-26-00156 Contract Terms and Conditions.pdf | ||
| 1-Drug Free Workplace Form.doc.doc | DOC document | |
| 4-Direct Deposit Authorization Form 5.15.2025.pdf.pdf | ||
| 6-Attachment A.pdf | ||
| 8-Appendix A.pdf | ||
| 12-RFP-26-00156 Insurance Requirements.pdf |
Show all 12
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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 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. “Controlling interest” shall have the meaning set forth in Florida Statutes Section 287.138(1)(a).
(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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