Foreign_Countries_of_Concern_Affidavit_12.11.2025.pdf
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- Solicitation number
- 26-0234-RFP
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
Foreign Country of Concern Affidavit for Pinellas County Janitorial Services Contract
This is a notarized affidavit form required by Pinellas County, Florida for contractors bidding on the Janitorial Services for Construction and Property Management Facilities contract (RFP 26-0234-RFP). The affidavit certifies that the contractor is not owned by, controlled by, or organized under the laws of a Foreign Country of Concern as defined by Section 287.138, Florida Statutes. Contractors must complete and notarize this document prior to contract award. The affidavit applies to any contractor seeking to enter into, renew, or extend a contract with Pinellas County that would grant access to an individual's Personal Identifying Information. Proposals for the janitorial services contract are due March 17, 2026, at 3:00 p.m., with questions due by March 12, 2026, at 2:00 p.m. The contract term is 36 months from the award date with two optional 12-month renewal periods available at the County's discretion.
Foreign Countries of Concern are specifically identified 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, and the Syrian Arab Republic. Controlling Interest is defined as possessing 25 percent or more of voting interests or profit entitlements. The affidavit must be signed by an authorized contractor representative under penalties of perjury, notarized before a notary public, and include the contractor's Federal Work Authorization User Identification Number and Pinellas County contract number. The previous janitorial contract was held by High Sources Inc. under Contract 23-0230-ITB with an annual estimated expenditure of $1,852,178.28 and a total three-year value of $5,556,534.84.
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Foreign Country 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: |
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| 2: |
| Notary Name: |
| Expiration Date: |
| Check Box3: Off |
| Check Box4: Off |
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