Contractor's Statutory Compliance Affidavit.pdf
PDF 163 KB Posted
- Attached to
- 5th District Court of Appeal Security Upgrades
- Solicitation number
- ITN-14562
- Issued by
- Leon County, Florida
About this file
This is a Contractor's Statutory Compliance Affidavit required by the State of Florida for the 5th District Court of Appeal Security Upgrades project. The affidavit applies to any contractor or business entity seeking to enter into a contract with the 5th District Court of Appeal, which operates under the Office of the State Courts Administrator (OSCA). The document serves as a formal certification that the contracting business entity complies with Florida statutory requirements governing state and local contracts. The affidavit does not specify particular products, services, quantities, response dates, due dates, site visits, bidders' meetings, award dates, or contract terms, as it functions as a compliance document rather than a scope of work or project specification document.
The affidavit requires contractors to certify under penalty of perjury that their business entity is not owned by or controlled by a foreign country of concern as defined by Florida Statutes Section 287.138, is not organized under the laws of or principally located in a foreign country of concern, does not engage in forced labor practices, and does not engage in human trafficking or related violations as defined by Sections 287.1346 and 787 of the Florida Statutes. Contractors must provide their business legal name, address, and taxpayer identification number and must notify the contract manager within ten calendar days of any changes that would affect the affidavit's accuracy, and within thirty calendar days of learning that any subcontractor or vendor violates compliance requirements. Failure to provide accurate information or timely notification may result in contract termination, criminal penalties for perjury, civil and criminal sanctions, prohibitions from conducting business with Florida governmental entities, and suspension or revocation of state business licenses and certifications.
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Text version
Contractors Affidavit v.1.00 Page | 1 rev 6/2024
CONTRACTOR’S STATUTORY COMPLIANCE AFFIDAVIT
I, _____________________________________, am an officer or authorized representative of the business entity shown below. I hereby acknowledge on behalf of my business or business entity that I am aware that governmental entities of the State of Florida are prohibited from entering into, amending, extending, and renewing certain contracts and agreements with foreign countries of concern, pursuant to section 287.138, Florida Statutes, business entities that engage in forced labor and human trafficking practices, pursuant to sections 287.1346, and 786.06(13), Florida Statutes.
Business or Business Entity Legal Name:
Business or Business Entity Legal Address:
Business or Business Entity Taxpayer Identification Number:
I hereby certify under penalty of perjury that:
• My business entity is not owned by a foreign country of concern, as defined by section 287.138, Florida Statutes.
• No foreign country of concern has a controlling interest in my business entity, as defined by section 287.138, Florida Statutes.
• My business entity is not organized under the laws of or has its principal place of business in a foreign country of concern as defined by section 287.138, Florida Statutes.
• My business entity does not engage in forced labor practices, as defined by section 287.1346, Florida Statutes.
• My business entity does not engage in human trafficking, as defined by section 787.06, Florida Statutes.
• My business entity does not employ or engage any person who performs any of the activities in section 787.30, Florida Statutes.
I have been advised that, in addition to criminal penalties for perjury for providing false information on this affidavit, my failure to comply with the requirements of sections 287.1346 and 287.138, and chapter 787, Florida Statutes, may result in civil and criminal penalties, prohibitions against doing business with any governmental entity of the State of Florida the suspension or revocation of all business or professional licenses and certifications issued by the State of Florida.
Contractors Affidavit v.1.00 Page | 2 rev 6/2024
By signing this affidavit, I agree that I will notify the Contract Manager within ten (10) calendar days of any change in my business entity status that would make any statement made on this affidavit untrue and within thirty (30) calendar days of gaining direct knowledge that any subcontractor or vendor is in violation of any of the requirements of sections 287.1346 and 787, Florida Statutes. I further acknowledge that the failure to make the appropriate notification will result in the immediate termination of my contract.
I HEREBY AFFIRM AND VERIFY THAT THE FOREGOING IS TRUE AND CORRECT.
Sole Proprietor/Authorized Representative
Printed Name
STATE OF _______________________
COUNTY OF _____________________
Sworn to (or Affirmed) and Subscribed Before Me By Means of ☐ Physical Presence or ☐ Online Notarization this ___________ day of __________________, 202__, by ________________________________________, Who ☐ Is Personally Known to Me or ☐ Produced Identification.
Type of Identification Produced: _________________________
Signature of Notary Public
Printed Name of Notary Public Administering Oath Pursuant to §117.03, Florida Statutes
| am an officer or authorized representative of the: |
| Business or Business Entity Legal Name: |
| Business or Business Entity Legal Address: |
| Business or Business Entity Legal Address_2: |
| Business or Business Entity Legal Address_3: |
| Business or Business Entity Taxpayer Identification Number: |
| Printed Name: |
| STATE OF: |
| COUNTY OF: |
| Physical Presence or: Off |
| Online Notarization: Off |
| this: |
| day of: |
| by: |
| Is Personally Known to Me or: Off |
| Produced Identification: Off |
| Type of Identification Produced 1: |
| Printed Name of Notary Public Administering Oath Pursuant to 11703 Florida Statutes: |
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