Foreign_Countries_affidavit_9.23.25.pdf
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- Attached to
- Milk, Dairy and Non-Dairy
- Solicitation number
- 002-DW-0326
- Issued by
- Florida
About this file
This is an affidavit form required by the State of Florida for vendor compliance with Section 287.138, Florida Statutes, regarding foreign countries of concern. The affidavit applies to the procurement of milk, dairy, and non-dairy products as outlined in the related Request for Proposal. Vendors must complete and have notarized this affidavit as a condition of contract eligibility with Florida governmental entities that may grant or allow access to personal identifying information.
The affidavit requires the authorized vendor representative to certify under penalty of perjury that the vendor is not owned by, does not have controlling interest from, and is not organized under the laws of or principally based in 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. The form must be signed by an authorized representative and acknowledged before a notary public. Effective January 1, 2024, this affidavit is a mandatory compliance requirement for all vendors seeking to contract with Florida governmental entities, ensuring adherence to state restrictions on foreign ownership and control related to specified countries of concern.
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Text version
Affidavit Regarding Foreign Countries of Concern
State of Florida County of __________________
Name of Vendor: _____________________________________________________________________
Address: ____________________________________________________________________________
Phone Number: ______________________________________________________________________
Authorized Representative’s Name: _____________________________________________________
Authorized Representative’s Title: _______________________________________________________
Effective January 1, 2024, Section 287.138, Florida Statutes, prohibits a Florida governmental entity from entering into a contract that may grant or allow access to any individual’s personal identifying information unless the contracting entity furnishes an affidavit signed by an officer or representative under penalty of perjury concerning foreign countries of concern.
As the person authorized to sign on behalf of the vendor, I certify that:
• The vendor is not owned by 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, or by any agency of or any other entity of significant control of any of such foreign country of concern.
• The government of 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 does not have a controlling interest in the vendor.
• The vendor is not organized under the laws of and does not have its principal place of business in 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.
Under penalty of perjury, I declare that I have read the foregoing document and that the facts stated in it are true.
Signature of Authorized Representative: _______________________________________________
The foregoing instrument was acknowledged before me this _____ day of _____, 20____, by _________________________, as Authorized Representative of the above-named Vendor who is (___) personally known to me or (____) produced a _______ driver’s license as identification.
Notary Public, State of _____________________ Commission no.: __________________________ My commission expires:____________________
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