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 solicitation 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 RFP seeks comprehensive burial and cremation services to manage approximately 1,060 calls for service annually, including disposition processing for approximately 720 claimed and unclaimed human remains (650 adults, 50 veterans, and 20 stillborn or infant cases). Services include administration, eligibility determination, direct cremation, embalming, 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 for up to 100 concurrent bodies, and demonstrate a minimum of five years of experience performing similar services for a governmental organization. Proposals must be submitted by April 14, 2026, at 3:00 PM via the OpenGov procurement website, with questions due by March 31, 2026, at 12:00 PM. The contract term is five years from the date of award with no scheduled site visits or pre-conference meetings.
Bidders must submit the Foreign Countries of Concern Affidavit certifying that the contractor is not owned by or controlled by entities from China, Russia, Iran, North Korea, Cuba, Venezuela, or Syria, along with a Human Trafficking Affidavit, Common Carrier Attestation, and executed HIPAA Business Associate Agreement. Contractors must maintain commercial general liability insurance of $1,000,000, professional liability insurance of $1,000,000, and workers' compensation insurance as required by Florida law. Pricing is capped at a total annual bid amount of $30,000, with an annual funding estimate not exceeding $550,000. 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 without reported set-asides for disadvantaged enterprises, and no incumbent vendor information is referenced in the available documentation.
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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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File details come from the government source that posted it. Updated .