CONTRACTING_WITH_ENTITIES_OF_FOREIGN_COUNTRIES_OF_CONCERN_PROHIBITED_AFFIDAVIT.pdf
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- Attached to
- Speech and Language Services State and local contract opportunity
- Solicitation number
- 24127A-RFP-DST
- Issued by
- Florida
About this file
This is a Contracting with Entities of Foreign Countries of Concern Prohibited Affidavit required by Florida Statutes Section 287.138 for Hillsborough County Public Schools (HCPS) in connection with Request for Proposals No. 24127-RFP-DST for speech-language pathology services. The affidavit must be completed and executed by an authorized representative of any proposer or contractor submitting a bid or proposal to HCPS, and the associated bid or proposal will not be accepted without this completed form. The affidavit certifies that the proposer's legal company name does not meet any of the criteria prohibiting contracting with entities owned by, controlled by, or organized under the laws of foreign countries of concern, which are defined as 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. "Controlling interest" is presumed to exist when a person or entity directly or indirectly holds voting rights or profit entitlements of 25 percent or more in a company.
The affidavit is executed under penalties of perjury pursuant to Florida Statutes Section 95.525, requiring the authorized representative to attest under oath that the facts stated are true. No pricing terms, set-asides, or funding information are addressed in this compliance document. This affidavit represents a mandatory compliance requirement for all proposers responding to the HCPS speech and language services solicitation and must be submitted prior to contract award or execution.
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Text version
CONTRACTING WITH ENTITIES OF FOREIGN COUNTRIES OF CONCERN PROHIBITED AFFIDAVIT
The Contracting with Entities of Foreign Countries of Concern Prohibited Affidavit Form (“Form”) is required by § 287.138, Florida Statutes, which is deemed as being expressly incorporated into this Form. This Affidavit must be completed by a person authorized to make this attestation on behalf of the Proposer/Contractor for the purpose of submitting a bid, proposal, quote, or other response, or otherwise entering into a contract with the HCPS. The associated bid, proposal, quote, or other response will not be accepted unless and until this completed and executed Affidavit is submitted to HCPS.
“Controlling interest” means possession of the power to direct or cause the direction of the management or policies of a company, whether through ownership of securities, by contract, or otherwise. A person or entity that directly or indirectly has the right to vote 25 percent or more of the voting interests of the company or is entitled to 25 percent or more of its profits is presumed to possess a controlling interest.
“Foreign country of concern” means 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, including any agency of or any other entity of significant control of such foreign country of concern.
“Governmental entity” means any state, county, district, authority, or municipal officer, department, division, board, bureau, commission, or other separate unit of government created or established by law including, but not limited to, the Commission on Ethics, the Public Service Commission, the Office of Public Counsel, and any other public or private agency, person, partnership, corporation, or business entity acting on behalf of any public agency.
A governmental entity may not knowingly enter into a contract with an entity which would give access to an individual’s personal identifying information if:
(a) The entity is owned by the government of a foreign country of concern;
(b) The government of a foreign country of concern has a controlling interest in the entity; or
(c) The entity is organized under the laws of or has its principal place of business in a foreign country of concern.
Legal Company Name ( ____________ _____) does not meet any of the criteria set forth in paragraphs 2(a) – (c) of § 287.138, Florida Statutes.
Pursuant to § 95.525, Florida Statutes, under penalties of perjury, I declare that I have read the foregoing statement and that the facts stated in it are true.
Print Name of Proposer/Contractor’s Authorized Representative
Title of Proposer/Contractor's Authorized
Signature of Proposer/Contractor’s Authorized
Date
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