Foreign_Countries_of_Concern_Affidavit_12.11.2025.pdf
PDF 128 KB Posted
- Attached to
- Artificial Reef - Tire Removal Project State and local contract opportunity
- Solicitation number
- 26-0349-RFP
- Issued by
- Pinellas County, Florida
About this file
This is a Foreign Countries of Concern Affidavit required by Pinellas County, Florida for contractors seeking to bid on the Artificial Reef - Tire Removal Project. The affidavit certifies that the contractor entity is not owned by, does not have a controlling interest from, and is not organized under the laws of any designated Foreign Country of Concern, including 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, in compliance with Florida Statutes Section 287.138. The document requires completion and notarization by an authorized representative of any bidder submitting a proposal, bid, or entering into a contract with Pinellas County that would grant access to Personal Identifying Information. The affidavit must be signed under penalties of perjury and acknowledged before a notary public, with fields for the contractor name, Federal Work Authorization User Identification Number, contract name and number, notary information, and identification details.
This affidavit is a mandatory compliance requirement for the tire removal project, which involves removing approximately 3,300 tires from five artificial reef areas off the Pinellas County coast. Contractors must submit the completed and notarized affidavit along with other required compliance documents including a Human Trafficking Affidavit, Common Carrier Attestation, and E-Verify registration. Proposals are due electronically through the OpenGov procurement website by April 16, 2026 at 3:00 p.m., with a question submission deadline of March 31, 2026 at 12:00 p.m. The contract term is twelve months from the date of award with one optional twelve-month renewal period available at the same prices, terms, and conditions subject to County approval.
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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: _________________________________________
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| 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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| Notary Name: |
| Expiration Date: |
| Check Box3: Off |
| Check Box4: Off |
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