Foreign_Countries_of_Concern_Affidavit_02.05.2025.pdf
PDF 115 KB Posted
- Attached to
- SES Learning Management State and local contract opportunity
- Solicitation number
- 25-0653-RFP
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This is a Foreign Countries of Concern Affidavit form required by Pinellas County, Florida for contractors seeking to enter into, renew, or extend contracts that would grant access to Personal Identifying Information. The affidavit certifies that the contractor is not owned by the government of a Foreign Country of Concern, does not have a Controlling Interest held by such a government, and is not organized under the laws of or principally located in a Foreign Country of Concern. The affidavit applies to the SES Learning Management System (LMS) RFP No. 25-0653-RFP, with proposals due October 9, 2025. Contractors must complete this affidavit as a condition of bid submission for the county's comprehensive, cloud-based Learning Management System procurement, which will support training and compliance needs across multiple departments with a 60-month initial contract term and two optional 12-month renewal periods.
The form requires an authorized representative of the contractor to sign under penalties of perjury and must be notarized. For purposes of this affidavit, "Foreign Country of Concern" is 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, including any agency or entity of significant control thereof. "Controlling Interest" is defined as possession of power to direct management or policies of a company, with a rebuttable presumption that any person or entity holding 25 percent or more of voting interests or entitled to 25 percent or more of profits possesses a controlling interest. Completion of this affidavit is mandatory for contract eligibility and must include the contractor name, Pinellas County contract number, notary acknowledgment, and Federal Work Authorization User Identification Number.
View the file
Other files for this state and local contract opportunity
Show all 27
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 |
File details come from the government source that posted it. Updated .