Affidavit_of_Compliance_with_Florida_Statutory_Provisions.pdf

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AFFIDAVIT OF COMPLIANCE WITH FLORIDA STATUTORY PROVISIONS

AFFIDAVIT OF COMPLIANCE WITH FOREIGN COUNTRIES OF CONCERN PURSUANT TO SECTION 287.138, FLORIDA STATUTES, CONVICTED VENDOR LIST (PUBLIC ENTITY CRIME) PURSUANT TO SECTION 287.133, FLORIDA STATUTES, PROHIBITION AGAINST CONTRACTING WITH SCRUTINIZED COMPANIES PURSUANT TO SECTION 287.135, FLORIDA STATUTES, PROHIBITION AGAINST HUMAN TRAFFICKING PURSUANT TO SECTION 787.06, FLORIDA STATUTES, AND COMPLIANCE WITH E-VERIFY PURSUANT TO SECTION 448.095, FLORIDA STATUTES

The undersigned Affiant, on behalf of the Business Entity listed below, hereby attests under penalty of perjury as follows:

Public Entity Crimes

1. Affiant understands that a “person” or “affiliate” who has been placed on the “convicted vendor list” following a “conviction” for a “public entity crime” (as those terms are defined in Section 287.133, Florida Statutes) for a period of 36 months following the date of being placed on the convicted vendor list, is ineligible to contract with or submit a bid, proposal or reply to contract with the City of Tampa. Business Entities placed on either the “discriminatory vendor list” or “antitrust vendor list” are ineligible to transact business with the City of Tampa.

2. Affiant understands and attests that neither Affiant, nor any person or affiliate of the Business Entity, nor the Business Entity have been placed on any of the above referenced vendor lists that would render the Business Entity ineligible to contract with or submit a bid, proposal or reply to contract with the City of Tampa.

Scrutinized Companies

3. Affiant understands that pursuant to Section 287.135(2)(a), Florida Statutes, the Business Entity would be ineligible to contract with or submit a bid, proposal or reply to contract with the City of Tampa if the Business Entity is on the “Scrutinized Companies that Boycott Israel List” (created pursuant to Section 215.4725, Florida Statutes) or is engaged in a boycott of Israel. If the value of the contract is one million dollars or more if, at the time of bidding on, submitting a proposal or reply for, or entering into or renewing a contract, the Entity is ineligible to contract with the City of Tampa if the Entity:

a. Is on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in Iran Terrorism Sectors List, created pursuant to Section 215.473, Florida Statutes; or

b. Is engaged in business operations in Cuba or Syria.

4. Affiant attests that neither Affiant nor the Business Entity are on the Scrutinized Companies that Boycott Israel List, Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in Iran Terrorism Sectors List, nor are we engaged in a boycott of Israel, and understand that any resulting contract may be terminated for a falsification of this Affidavit.

E-Verify

5. Affiant understands and attests that pursuant to Section 448.095(5), Florida Statutes, the Business Entity must comply with Florida’s E-Verify law to enter into a contract with the City of Tampa.

6. The undersigned Business Entity is registered with and uses the United States Department of Homeland Security’s E-Verify system to verify the work authorization status of all new employees.

http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0200-0299/0215/Sections/0215.473.html

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7. No public employer has terminated a contract with the Business Entity pursuant to Section 448.095(5), Florida Statutes, within the year immediately preceding the date of contracting or submitting a bid, proposal or replay to contract with the City of Tampa.

8. Business Entity is currently in compliance and will remain in compliance, for the duration of any contract with the City of Tampa, with all requirements of Section 448.095(5), Florida Statutes.

9. Affiant understands and attests that, if there is a good faith belief that the Business Entity has knowingly violated Section 448.09(1), Florida Statutes, there is an obligation on the part of the City of Tampa to terminate a contract pursuant to Section 448.095(5), Florida Statutes.

10. Affiant understands and attests that, if there is a good faith belief that one of Business Entity’s subcontractor(s) has knowingly violated the Section 448.09(1), Florida Statutes, but the Business Entity has otherwise complied with its obligations thereunder, then the Business Entity will be required to immediately terminate the contract with the subcontractor in order to continue providing services to the City of Tampa.

Anti-Human Trafficking

11. Affiant hereby understands and attests that the undersigned Business Entity does not use coercion of labor or services as those terms are defined in section 787.06, Florida Statutes.

Compliance with Foreign Countries of Concern

12. Affiant, on behalf of the Business Entity attest to the following:

a. Business Entity is not owned by the government of a foreign country of concern as defined in

Section 287.138, Florida Statutes. (Source: § 287.138(2)(a), Florida Statutes.)

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

Business Entity. (Source: § 287.138(2)(b), Florida Statutes.)

c. Business Entity is not organized under the laws of, and does not have a principal place of business in a foreign country of concern. (Source: § 287.138(2)(c), Florida Statutes.)

The undersigned is authorized to execute this Affidavit on behalf of the Business Entity.

The undersigned further sayeth naught.

Date: ________________________ (Affiant) Signed: ______________________________

Business Entity Name: _________________ Name: _______________________________ Title: _________________________________

STATE OF _____________________

COUNTY OF ___________________

SWORN to (or affirmed) and subscribed before me, by means of physical presence or online notarization, this ______ day of ________________, 20__, by _____________________, as ________________________, who is personally known to me or who has produced _________________ as identification.

[AFFIX NOTARY SEAL/STAMP] ____________________________

Signature of Notary

Name: ______________________ (Print or Type Name)

Notary Public: State of Florida My Commission Expires_______