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 School Board of Polk County, Florida, for a classroom and office supplies procurement contract (Bid 029-RW-0126). The affidavit certifies vendor compliance with Florida Statute Section 287.138, effective January 1, 2024, which prohibits state and local governmental entities from contracting with vendors that are owned, controlled, or organized by entities from specified foreign countries of concern. Sealed bids are due electronically through VendorLink by 3:00 PM on January 8, 2026, with an anticipated award recommendation on January 15, 2026, and Superintendent approval targeted for January 20, 2026. The contract period runs from February 1, 2026, through July 31, 2026, covering the procurement of classroom and office supplies including binders, index cards, clipboards, file folders, pencils, post-it notes, staplers, chart tablets, and transparent tape for delivery to the School Board's warehouse in Bartow, Florida.
The vendor's authorized representative must sign the affidavit under penalty of perjury, certifying that the vendor 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 submitted as part of the bid package. The anticipated total bid value is approximately $88,000 based on historical data. Vendors must also comply with E-Verify employment eligibility verification requirements and register on VendorLink with current contact information. Pricing must remain firm for the entire contract duration and include freight and handling charges, with no substitutions permitted except in cases of manufacturer discontinuation.
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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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