Affidavit_Foreign_Countries.pdf
PDF 99 KB Posted
- Attached to
- Armored Car Services
- Solicitation number
- 001-MJ-0727
- Issued by
- Polk County, Florida
About this file
This is an Affidavit Regarding Foreign Countries of Concern required by the School Board of Polk County, Florida for vendors seeking to provide armored car and secure courier services. The affidavit, effective January 1, 2024, implements Florida Statutes Section 287.138, which mandates that Florida governmental entities obtain signed affidavits from vendors before awarding contracts that may grant access to personal identifying information. The document requires the vendor's authorized representative to certify under penalty of perjury that the vendor is not owned by, does not have controlling interest from, and is not organized under the laws of seven specified foreign countries of concern: 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 signed by an authorized officer or representative of the vendor and notarized before a notary public. The form requires completion of vendor information including name, address, phone number, and the authorized representative's name and title. The signatory certifies the accuracy of all statements under penalty of perjury, and a notary public must acknowledge the signature, verify identification, and provide their commission number and expiration date. This affidavit is a compliance requirement for the armored car services contract opportunity with Polk County Schools and must be submitted as part of the vendor's bid documentation.
View the file
Other files
Show all 17
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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:____________________
File details come from the government source that posted it. Updated .