Foreign_Countries_of_Concern_Affidavit_02.05.2025_(1).pdf
PDF 115 KB Posted
- Solicitation number
- 26-0394-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This is a Foreign Country of Concern Affidavit form required by Pinellas County, Florida for contractors bidding on the Solid Waste Administration Building HVAC Renovation project (ITB-C #26-0394-ITB-C). The affidavit must be completed and notarized by an authorized representative of any contractor submitting a bid or proposal that would grant access to Personal Identifying Information. The form certifies that the contractor is not owned by, does not have controlling interest held by, and is not organized under the laws of or principally located in a Foreign Country of Concern, defined as 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. For purposes of the affidavit, "Controlling Interest" is defined as possession of power to direct management or policies through ownership of securities or contract, with a presumption of control when a person or entity directly or indirectly holds voting rights or profit entitlements of 25 percent or more. Step One qualification submissions, including this affidavit, are due April 21, 2026 at 3:00 p.m., with sealed bids due May 5, 2026 at 3:00 p.m.
The affidavit form requires completion of contractor name, authorized representative signature, date, Federal Work Authorization User Identification Number, and Pinellas County contract number and name, followed by notarization before a notary public. The notarization section documents the method of acknowledgment (physical presence or online notarization), the date, the corporation's name and type, the notary's name and commission expiration date, and the type of identification provided. This affidavit is one of several mandatory compliance requirements for the HVAC renovation project, alongside E-Verify affidavits, Common Carrier attestations, and Human Trafficking affidavits, all of which must be notarized prior to bid submission.
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Text version
Foreign County of Concern Affidavit
I hereby certify that ____________________________________( the “Contractor”) is not an entity owned by the government of a Foreign Country of Concern; the government of a Foreign Country of Concern does not have a Controlling Interest in the entity; nor is the entity organized under the laws of or has its principal place of business in a Foreign Country of Concern, and is otherwise in full compliance with Section §287.138, Florida Statutes.
This Affidavit must be completed by an authorized representative of the Contractor submitting a bid, proposal, reply to, or entering into, renewing, or extending, a contract with the County, which would grant the entity access to an individual’s Personal Identifying Information.
For purposes of this Affidavit:
“Foreign Country of Concern” means 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, including any agency of or any other entity of significant control of such foreign country of concern.
“Controlling Interest” means possession of the power to direct or cause the direction of the management or policies of a company, whether through ownership of securities, by contract, or otherwise. A person or entity that directly or indirectly has the right to vote 25 percent or more of the voting interests of the company or is entitled to 25 percent or more of its profits is presumed to possess a controlling interest.
Under penalties of perjury, I declare that I have read the foregoing affidavit and that the facts stated in it are true.
Signature: ______________________________
Print Name: ______________________________
Date: ______________________________
Federal Work Authorization User Identification No.: _____________________________
Name of Pinellas County Contract and Contract No.: ____________________________
STATE OF FLORIDA COUNTY OF ________________
The foregoing instrument was acknowledged before me by means of 1) physical presence __ or 2) online notarization___, this __________________________ (date) by ____________________________ of _____________________________________, a __________________________________ corporation, on behalf of the corporation.
He/she is personally known to me or has produced __________________________________ as identification.
[Notary Seal]
Notary Public: _________________________________________
Name typed, printed, or stamped: _________________________________________
My Commission Expires: _________________________________________
| Print Name: |
| Date: |
| Federal Work Authorization User Identification No: |
| Name of Pinellas County Contract and Contract No: |
| Notary Public: |
| Contractor Name: |
| County Name: |
| Notarization Date: |
| Name: |
| Type of Identification: |
| 1: |
| 2: |
| Notary Name: |
| Expiration Date: |
| Check Box3: Off |
| Check Box4: Off |
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