CONTRACTING_WITH_ENTITIES_OF_FOREIGN_COUNTRIES_OF_CONCERN_PROHIBITED_AFFIDAVIT.pdf
PDF 93 KB Posted
- Attached to
- Wellness Program State and local contract opportunity
- Solicitation number
- 25477-RFP-DST
- Issued by
- Florida
About this file
This is a required affidavit form for the Hillsborough County Public Schools (HCPS) Wellness Program contract opportunity in Florida, mandated by Florida Statutes Section 287.138. The affidavit must be completed and executed by an authorized representative of any proposer or contractor submitting a bid, proposal, or quote for this contract. The form certifies that the contracting entity does not meet any of the prohibited criteria regarding foreign countries of concern, and submission of the completed affidavit is a prerequisite for HCPS to accept any bid or proposal. The wellness program RFP requires responses by October 2, 2025, and organizations must meet all minimum requirements to be fully considered for evaluation.
The affidavit prohibits contracting with entities that are owned by, have a controlling interest held by, or are organized under the laws of or principally operate in a foreign country of concern—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 defined as possessing 25 percent or more of voting interests or profits. The affidavit must be signed under penalties of perjury by the proposer's authorized representative and includes specific language confirming the legal company name does not meet any of the prohibited criteria outlined in the statute.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| 25477_Notice_of_Intent_to_Award.pdf | ||
| 25477_Notice_of_Short_List_.pdf | ||
| Addendum_1.pdf | ||
| 25477-RFP-DST_Wellness_Program.pdf | ||
| SMALL_BUSINESS_ENCOURAGEMENT_PROGRAM9.2.25.pdf | ||
| Vendor_Registration_Form_07.10.25.pdf | ||
| STATEMENT_OF_NO_BID.pdf | ||
| Attachment_A_HCPS_Wellness_Program_RFP.xlsx | XLSX spreadsheet |
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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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