Affidavit_Foreign_Countries_9.23.25.pdf
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- Attached to
- Cafeteria, Classroom, Office, Library Furniture
- Solicitation number
- 040-MJ-0626
- Issued by
- Florida
About this file
This is an affidavit form issued by the State of Florida regarding vendor compliance with foreign countries of concern restrictions under Section 287.138, Florida Statutes, effective January 1, 2024. The affidavit applies to vendors seeking to contract with Florida governmental entities for the procurement of cafeteria, classroom, office, and library furniture under a one-year contract opportunity. The form requires the authorized representative of the vendor to certify under penalty of perjury that the vendor meets specific ownership and control requirements mandated by Florida law.
The vendor must affirm through the signed affidavit that it is not owned by, does not have controlling interest from, and is not organized under the laws of 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. The affidavit must be notarized and signed by an authorized officer or representative of the vendor. This document serves as a prerequisite for contract eligibility and requires vendors to provide their business information, including name, address, phone number, and authorized representative details. Failure to submit a compliant affidavit or providing false information subjects the vendor to perjury penalties under Florida law.
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Text version
Affidavit Regarding Foreign Countries of Concern
State of Florida County of __________________
Name of Vendor: _____________________________________________________________________
Address: ____________________________________________________________________________
Phone Number: ______________________________________________________________________
Authorized Representative’s Name: _____________________________________________________
Authorized Representative’s Title: _______________________________________________________
Effective January 1, 2024, Section 287.138, Florida Statutes, prohibits a Florida governmental entity from entering into a contract that may grant or allow access to any individual’s personal identifying information unless the contracting entity furnishes an affidavit signed by an officer or representative under penalty of perjury concerning foreign countries of concern.
As the person authorized to sign on behalf of the vendor, I certify that:
• The vendor is not owned by 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, or by any agency of or any other entity of significant control of any of such foreign country of concern.
• The government of 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 does not have a controlling interest in the vendor.
• The vendor is not organized under the laws of and does not have its principal place of business in 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.
Under penalty of perjury, I declare that I have read the foregoing document and that the facts stated in it are true.
Signature of Authorized Representative: _______________________________________________
The foregoing instrument was acknowledged before me this _____ day of _____, 20____, by _________________________, as Authorized Representative of the above-named Vendor who is (___) personally known to me or (____) produced a _______ driver’s license as identification.
Notary Public, State of _____________________ Commission no.: __________________________ My commission expires:____________________
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