Foreign_Countries_affidavit.pdf
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- Attached to
- Substitute Teaching Services
- Solicitation number
- 037-DW-0526
- Issued by
- Florida
About this file
This is an affidavit document required by the State of Florida for vendor compliance with Section 287.138, Florida Statutes, applicable to Polk County Public Schools' solicitation for Substitute Teaching Services. The affidavit must be executed by an authorized representative of any vendor seeking to contract with the governmental entity and must be notarized. The document became effective January 1, 2024, and applies to any contract that may grant or allow access to personal identifying information. Vendors are required to certify under penalty of perjury that they meet specific ownership and operational criteria related to foreign countries of concern.
The affidavit requires vendors to affirm that they are not owned by or controlled 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 Nicolas Maduro, or the Syrian Arab Republic. Vendors must also certify that these foreign entities do not have a controlling interest in their operations and that the vendor is not organized under the laws of or principally based in any of these designated countries. The document mandates that the authorized representative sign under penalty of perjury and that the affidavit be acknowledged before a notary public. Failure to provide this certification would preclude a vendor from entering into a contract with Polk County Public Schools for substitute teaching services.
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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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