Foreign_Countries_of_Concern_Affidavit_12.11.2025.pdf

PDF 128 KB Posted

Attached to
Indigent Burial and Cremation Services
Solicitation number
26-0292-RFP
Issued by
Pinellas County, Clewiston City, Florida

About this file

This is a Foreign Countries of Concern Affidavit required by Pinellas County, Florida, for RFP 26-0292-RFP, a competitive procurement for indigent burial and cremation services. The affidavit must be completed and notarized by an authorized representative of any contractor bidding on or entering into a contract with the county that would provide access to personal identifying information. The procurement seeks qualified providers to deliver comprehensive indigent burial and cremation services to approximately 1,060 annual calls for service, encompassing disposition of approximately 720 claimed and unclaimed human remains annually, including 650 adults, 50 veterans, and 20 stillborn or infant cases. The scope includes a detailed menu of services such as administration and eligibility determination, direct cremation, body embalming, cremains urns, burial containers, refrigeration and storage, body removal and transport, cremains scattering, cemetery lots, hearse services, and three bundled package options. Qualified bidders must hold a current Florida funeral director license, maintain an FDEP-certified incinerator facility, provide minimum refrigerated storage capacity for up to 100 concurrent bodies, and demonstrate a minimum of five years of experience performing similar services for a governmental organization. Questions must be submitted by March 31, 2026, at 12:00 PM, with proposals due on April 14, 2026, at 3:00 PM via the OpenGov procurement website. The contract term is five years from the date of award, with no scheduled site visits or pre-conference meetings.

Evaluation will be based on qualifications (35 percent), scope of work (25 percent), deliverables (25 percent), and compensation (15 percent). The annual funding estimate does not exceed $550,000, with pricing capped at a total annual bid amount of $30,000; all submitted pricing must remain fixed regardless of whether actual annual case volumes exceed or fall below projected numbers. The solicitation is open to all qualified providers meeting minimum qualifications with no reported set-asides for disadvantaged enterprises and no incumbent vendor information referenced. Bidders must comply with multiple compliance requirements, including submission of a Foreign Countries of Concern Affidavit certifying non-ownership or control by designated foreign countries, a Human Trafficking Affidavit, a Common Carrier Attestation, and execution of a HIPAA Business Associate Agreement. Bidders must carry commercial general liability insurance of $1,000,000, professional liability insurance of $1,000,000, and workers' compensation insurance as required by Florida law.

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Text version

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:
1:
2:
Notary Name:
Expiration Date:
Check Box3: Off
Check Box4: Off

File details come from the government source that posted it. Updated .