Foreign_Countries_affidavit_9.23.25.pdf
PDF 99 KB Posted
- Attached to
- ERCES Inspections State and local contract opportunity
- Solicitation number
- 033-TD-0426
- Issued by
- Florida
About this file
This is an affidavit form required by the State of Florida under Section 287.138, Florida Statutes, applicable to vendors seeking to contract with Florida governmental entities for work involving access to personal identifying information. The affidavit applies to the ERCES Inspections contract opportunity, which involves the provision of required semi-annual inspections, annual inspections and testing, and 5-year grid re-testing of all Emergency Responder Communication Enhancement Systems.
The affidavit requires that vendors certify, under penalty of perjury, that neither the vendor nor any entity with significant control of the vendor is owned by or organized under the laws 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 Nicolas Maduro, or the Syrian Arab Republic. The authorized representative of the vendor must sign the affidavit before a notary public, providing vendor name, address, phone number, representative name, and representative title. This certification became effective January 1, 2024, and represents a requirement for contract eligibility rather than a pricing or performance specification.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| Contact_Information_Form.pdf | ||
| 033-TD-0426_ERCES_Inspections_final.pdf | ||
| Conflict_of_Interest_Statement.pdf | ||
| PCSB_Form_Contract_Addendum_7.17.25.pdf | ||
| Addendum_Acknowledgment_Form.pdf | ||
| Coercion_affidavit_10.16.25.pdf | ||
| Reference_Request.docx | DOCX document | |
| Drug_Free_Workplace_Certification_Form.pdf |
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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:____________________
File details come from the government source that posted it. Updated .