Affidavit_Regarding_Foreign_Countries_of_Concern_09.23.2025.pdf
PDF 99 KB Posted
- Attached to
- Classroom and Office Supplies - Stock
- Solicitation number
- 029-RW-0126
- Issued by
- Polk County, Florida
About this file
This is an Affidavit Regarding Foreign Countries of Concern required by the State of Florida for contract opportunities with state and local governmental entities. The affidavit applies to the Classroom and Office Supplies - Stock procurement bid issued by The School Board of Polk County for a 6-month contract to supply various classroom and office supplies to the district's warehouse in Bartow, Florida. Effective January 1, 2024, Florida Statute Section 287.138 mandates that any vendor seeking to contract with a Florida governmental entity and potentially grant or allow access to personal identifying information must execute this affidavit under penalty of perjury.
The affidavit requires the authorized vendor representative to certify that the company is not owned by, does not have controlling interest from, and is not organized under the laws of or principally based in any 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 vendor must provide the affidavit signed by an authorized officer or representative and notarized before submission, with the notary public confirming identification of the signatory. This compliance requirement must be satisfied prior to contract award regardless of other bid qualifications or pricing terms.
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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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