CONTRACTING_WITH_ENTITIES_OF_FOREIGN_COUNTRIES_OF_CONCERN_PROHIBITED_AFFIDAVIT.pdf

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Attached to
DRINKING FOUNTAIN AND ICE MACHINE FILTER SERVICES
Solicitation number
26233-ITB-MST
Issued by
Hillsborough County, Florida

About this file

This is a required affidavit form for contract submissions to Hillsborough County Public Schools (HCPS) in Florida, mandated by Florida Statute 287.138. The form requires an authorized representative of any proposer or contractor to certify that their entity does not meet any of the criteria prohibiting contracts with foreign entities of concern. Specifically, the affidavit must attest that the company is not owned by the government of a foreign country of concern, does not have a foreign country of concern government with a controlling interest, and is not organized under the laws of or principally located in a foreign country of concern. The identified foreign countries of concern include 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, and the Syrian Arab Republic. The affidavit applies to all bids, proposals, quotes, or responses submitted to HCPS and must be completed and executed before any bid or proposal will be accepted.

The form defines "controlling interest" as possession of power to direct management or policies of a company, with a presumption of controlling interest when a person or entity directly or indirectly has the right to vote twenty-five percent or more of voting interests or is entitled to twenty-five percent or more of profits. The attestation is made under penalty of perjury pursuant to Florida Statute 95.525, requiring the authorized representative's printed name, title, signature, and date. This affidavit is a mandatory compliance requirement for the drinking fountain and ice machine filter services contract opportunity with HCPS and must be submitted concurrently with the bid or proposal response.

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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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