CONTRACTING_WITH_ENTITIES_OF_FOREIGN_COUNTRIES_OF_CONCERN_PROHIBITED_AFFIDAVIT.pdf
PDF 93 KB Posted
- Attached to
- Medical/Rx
- Solicitation number
- 25598-RFP-DST
- Issued by
- Hillsborough County, Florida
About this file
This is a statutory affidavit form required by Florida Statutes Section 287.138 for the Hillsborough County Public Schools (HCPS) medical benefits and pharmacy services procurement (RFP 25598-DST). The affidavit must be completed and executed by an authorized representative of any proposer or contractor bidding on the contract and submitted with the proposal response. The form certifies compliance with foreign country restrictions and must be included for HCPS to accept the bid, proposal, quote, or other response. Proposals are due by December 12, 2025, through VendorLink, with the last day for technical questions on November 20, 2025. The contract will be effective January 1, 2027, and covers medical benefits, behavioral health, and pharmacy services for approximately 24,328 eligible HCPS employees, including active employees, under-age-65 retirees, Medicare-eligible retirees, and COBRA participants, with current enrollment of 19,121 participants.
The affidavit requires proposers to attest that their legal company does not meet any of three criteria: (1) being owned by the government of a foreign country of concern; (2) having a foreign country of concern government maintain controlling interest; or (3) being organized under the laws of or maintaining principal place of business in a foreign country of concern. "Foreign country of concern" is 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 when an entity directly or indirectly holds voting rights or profit entitlements of 25 percent or more. The declaration is made under penalties of perjury pursuant to Florida Statutes Section 95.525.
View the file
Other files
Show all 22
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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
File details come from the government source that posted it. Updated .