Attachment_E_Foreign_Country_of_Concern_(1).pdf
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- Solicitation number
- ITB-26-18-CW
- Issued by
- Volusia County, Florida
About this file
This is an affidavit form mandated by Florida Statutes Section 287.138 for use by the City of Port Orange in connection with its Mitigation Reconstruction of a Flood Prone Home Project. The affidavit requires vendors and contractors to certify under penalty of perjury that their entity is not owned by, does not have controlling interest from, and is not organized under the laws of or principally based in a Foreign Country of Concern as defined by Florida law. The form must be completed and signed by an authorized representative of the responding vendor, including the vendor name, Federal Employer Identification Number (FEIN), representative name and title, complete address, phone number, and email address.
The affidavit serves as a compliance mechanism to ensure that contractors granted access to personal identifying information through state and local contracts meet ownership and organizational independence requirements under Florida law. Completion and submission of this document is a necessary condition for contract eligibility, and false certification constitutes perjury under Florida statute. The form does not establish pricing terms, set-asides, or funding amounts but rather functions as a prerequisite eligibility verification document that must accompany vendor bid submissions for the Port Orange home reconstruction project.
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Text version
ATTACHMENT "E"
FOREIGN COUNTRY OF CONCERN AFFIDAVIT –
PERSONAL IDENTIFYING INFORMATION CONTRACT
Section 287.138, Florida Statutes, prohibits a Florida “Governmental entity”2 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.”3 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,”4 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 Respondent, I hereby attest that the company identified above in the section entitled “Respondent Vendor Name” 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.
2 As defined in Section 287.138 (1)(d), Florida Statutes.
3 As defined in Section 287.138 (1)(c), Florida Statutes.
4 As defined in Section 287.138 (1)(a), Florida Statutes.
Respondent Vendor Name:
Vendor FEIN:
Vendor’s Authorized Representative Name and Title:
Address:
City: State: Zip:
Phone Number:
Email Address: _
Certified By:
AUTHORIZED SIGNATURE
Print Name and Title:
Date:
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