Affidavit_Regarding_Foreign_Countries_of_Concern.pdf
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- Attached to
- Classroom and Office Supplies - Stock
- Solicitation number
- 003-RW-0727
- Issued by
- Polk County, Florida
About this file
This is an Affidavit Regarding Foreign Countries of Concern required by the State of Florida for the School Board of Polk County's classroom and office supplies procurement under ITB 003RW0727. The affidavit must be completed and notarized by an authorized representative of each bidding vendor prior to contract award. The procurement covers a six-month contract term for delivery of classroom and office supplies to The School Board of Polk County warehouse in Bartow, Florida. Bids were due July 16, 2026, and the procurement has closed as of the posting date of July 21, 2026.
Effective January 1, 2024, Florida Statutes Section 287.138 mandates that any vendor seeking to contract with a Florida governmental entity and provide access to personal identifying information must execute this affidavit under penalty of perjury. The affidavit requires the vendor's authorized representative to certify that the vendor is not owned by, does not have controlling interest from, and is not organized under the laws of or principally based 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 Nicolas Maduro, or the Syrian Arab Republic. The completed affidavit must be notarized and submitted as part of the bid documentation along with a Drug Free Workplace Certification and an Affidavit Regarding Coercion for Labor and Services.
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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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