Attachment_C_Foreign_Country_of_Concern_Affidavit.pdf
PDF 95 KB Posted
- Attached to
- Post Hurricane Ian Palm Replacement
- Solicitation number
- ITB 0066-24
- Issued by
- Lee County, Fort Lauderdale City, Florida
About this file
This document is Attachment F, a Foreign Country of Concern Affidavit form issued under Section 287.138 of Florida Statutes, applicable to governmental entities in Florida. The affidavit requires recipients of state contracts to certify that they are not owned by, controlled by, or principally located in a "Foreign Country of Concern" which could potentially grant access to personal identifying information.
The form requires the recipient to provide their company name, Federal Employer Identification Number (FEIN), authorized representative details, contact information, and an authorized signature. By signing, the representative attests under penalty of perjury that their organization does not have ownership, controlling interest, or primary business location in a designated foreign country. This affidavit is designed to protect personal identifying information and restrict contracts with entities from certain foreign countries deemed potentially sensitive or problematic by Florida state law.
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| Post_Hurricane_Ian_Palm_Replacement_(Addendum_#1_Revision).pdf | ||
| Local_MBE_Form.pdf | ||
| SERVICE_PROVIDER_AGREEMENT_(NON_CCNA)-DRAFT.pdf | ||
| Contract_(draft),_Construction.pdf | ||
| Federal_MBE_Form.pdf | ||
| Local_Preference_Affidavit.pdf | ||
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| Notice_of_Award.docx | DOCX document | |
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Text version
ATTACHMENT F
FOREIGN COUNTRY OF CONCERN AFFIDAVIT –
PERSONAL IDENTIFYING INFORMATION CONTRACT
Section 287.138, Florida Statutes, prohibits a Florida “Governmental entity”1 from entering into or extending contracts with any other entity whereby such a contract, or extension thereof, could grant the other entity access to an individual’s personal identifying information if that entity is associated with a “Foreign Country of Concern.”2 Specifically, section 287.138(2), Florida Statutes, prohibits such contracts with any entity that is owned by the government of a Foreign Country of Concern, any entity in which the government of a Foreign Country of Concern has a “controlling interest,”3 and any entity organized under the laws of or which has its principal place of business in a Foreign Country of Concern.
As the person authorized to sign on behalf of Recipient, I hereby attest that the company identified below in the section entitled “Recipient” is not an entity owned by the government of a Foreign Country of Concern, no government of a Foreign Country of Concern has a controlling interest in the entity, and the entity has not been organized under the laws of or has its principal place of business in a Foreign Country of Concern.
I understand that pursuant to section 287.138, Florida Statutes, I am submitting this affidavit under penalty of perjury.
1 As defined in Section 287.138 (1)(d), Florida Statutes.
2 As defined in Section 287.138 (1)(c), Florida Statutes.
3 As defined in Section 287.138 (1)(a), Florida Statutes.
Recipient Name:
Recipient FEIN:
Recipient’s Authorized Representative Name and Title:
Address:
City: State: Zip:
Phone Number:
Email Address: _
Certified By:
AUTHORIZED SIGNATURE
Print Name and Title:
Date:
File details come from the government source that posted it. Updated .