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 Contractor's Statutory Compliance Affidavit is a required document for vendors seeking to contract with the State of Florida and its governmental entities, specifically for the 5th District Court of Appeal Security Upgrades project (ITN #2025-002) managed by the Office of the State Courts Administrator. The affidavit serves as a certification that bidding contractors meet mandatory compliance requirements before engagement. A mandatory pre-proposal conference is scheduled for January 22, 2026, at 10:00 AM, with escorted site visits available January 22-23, 2026. Technical and cost replies are due February 11, 2026, at 4:00 PM, with the cost volume opening on February 25, 2026. The contract will commence on April 10, 2026, with an initial one-year term and potential renewals for up to three additional years based on satisfactory performance.
The affidavit requires the contractor's authorized representative to certify under penalty of perjury that the business entity is not owned by or does not have controlling interests from foreign countries of concern as defined by Florida Statute 287.138, is not organized under or principally located in such countries, and does not engage in forced labor or human trafficking practices as defined by Florida Statutes 287.1346 and 787.06. Contractors must notify the Contract Manager within ten calendar days of any changes to business entity status that would invalidate statements made on the affidavit and within thirty calendar days of discovering any subcontractor or vendor violations. Failure to provide appropriate notification results in immediate contract termination. The affidavit must be notarized and executed before a notary public, with violations subject to criminal penalties for perjury as well as civil and criminal penalties under Florida law, prohibitions from doing business with any Florida governmental entity, and suspension or revocation of all business and professional licenses and certifications issued by the State of Florida.
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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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