5-AFFIDAVIT OF COMPLIANCE - Denying Doing Business with a Foreign Country of Concern 02.26.2026.docx
DOCX document 17 KB Posted
- Attached to
- Payment and Program Management Software Platform
- Solicitation number
- RFP-26-00210
- Issued by
- Hillsborough County, Florida
About this file
This is an Affidavit of Compliance document required by Hillsborough County, Florida, for bidders and offerors seeking to contract with the county for a cloud-based payment and program management software platform estimated at $555,000 over a three-year period. The affidavit must be submitted with all bids and proposals and certifies that the bidding company does not have involvement with designated foreign countries of concern, as mandated by Florida Statutes Section 287.138(4)(a), effective January 1, 2024. The affidavit requires an authorized company representative to affirm under penalties of perjury that the company is not owned by the government of a Foreign Country of Concern, that such a government maintains no controlling interest in the company, and that the company is neither organized under the laws of nor maintains its principal place of business in a Foreign Country of Concern.
The Foreign Countries of Concern are specifically identified as 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, including any agencies or entities under their significant control. The affidavit must be executed by a duly authorized representative with sufficient knowledge of the company and notarized before a notary public. Failure to submit this affidavit with a bid or proposal will result in Hillsborough County's inability to accept the submission or enter into a contract with the bidding entity.
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Other files
| File | Type | Posted |
|---|---|---|
| 3-Substitute W9 Form.pdf.pdf | ||
| 2-Insurance Certificate.doc.doc | DOC document | |
| 8-RFP-26-00210 Exhibit 1 - Vendor Security Questionnaire - Outsourcing.xlsx | XLSX spreadsheet | |
| 9-RFP-26-00210 Insurance Requirements.pdf | ||
| 4-Direct Deposit Authorization Form 5.15.2025.pdf.pdf | ||
| 6-RFP-26-00210 Exhibit 3 - AI Security Questionnaire.xlsx | XLSX spreadsheet | |
| 7-RFP-26-00210 Exhibit 2 - Vendor Security Questionnaire - Software.xlsx | XLSX spreadsheet | |
| 1-Drug Free Workplace Form.doc.doc | DOC document | |
| 10-RFP-26-00210 Payment and Program Management Software Platform.pdf |
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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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