Foreign_Countries_of_Concern_Affidavit_02.05.2025.pdf
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- Solicitation number
- 25-0779-ITB
- Issued by
- Pinellas County, Florida
About this file
This is a Foreign Country of Concern Affidavit required by Pinellas County, Florida for contractors bidding on Invitation to Bid #25-0779-ITB for Overhead/Security Doors Maintenance, Repair and Replacement Services. The affidavit mandates that bidders certify they are not owned by, do not have a controlling interest held by, and are 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. The affidavit applies to any contractor entity that would receive access to personal identifying information through the contract. Controlling interest is defined as direct or indirect possession of power to direct management or policies, with a presumption of control at 25 percent or greater ownership of voting interests or profit entitlement. The affidavit must be completed by an authorized contractor representative, notarized before a Florida notary public, and submitted with the bid proposal due electronically via OpenGov by July 29, 2025, at 3:00 pm for the 60-month contract term valued at approximately $300,000.
The affidavit requires the contractor's authorized representative to sign under penalty of perjury, provide their Federal Work Authorization User Identification Number, and include the Pinellas County contract name and number. A notary public must acknowledge the affidavit through either physical presence or online notarization, verify the signatory's identity, and affix their notarial seal with expiration date. This compliance document is mandatory for contract execution and represents part of Pinellas County's broader procurement requirements, which also include human trafficking and common carrier attestations. No specific pricing, set-asides, or financial considerations are addressed within the affidavit itself, as it serves purely as a compliance certification mechanism to satisfy Florida Statutes Section 287.138 requirements for county contracting.
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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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