Foreign_Countries_of_Concern_Affidavit_12.11.2025.pdf
PDF 128 KB Posted
- Attached to
- 26-0449-RFP Rapid Rehousing Fiscal Administration & Service Provider Collaborative Program
- Solicitation number
- 26-0449-REQ
- Issued by
- Pinellas County, Florida
About this file
This is a Foreign Country of Concern Affidavit required by Pinellas County, Florida for the Rapid Rehousing Fiscal Administration & Service Provider Collaborative Program (RFP 26-0449-RFP). The affidavit must be completed and notarized by authorized representatives of any contractor submitting a bid, proposal, or entering into a contract with Pinellas County that would grant access to Personal Identifying Information. The document certifies that the contractor is not owned by, controlled by, or organized under the laws of a Foreign Country of Concern, defined as the People's Republic of China, Russian Federation, Islamic Republic of Iran, Democratic People's Republic of Korea, Republic of Cuba, Venezuelan regime of Nicolas Maduro, or Syrian Arab Republic. Controlling interest is presumed when a person or entity directly or indirectly holds voting rights of 25 percent or more or is entitled to 25 percent or more of profits. The affidavit requires the contractor's authorized representative signature, printed name, date, and Federal Work Authorization User Identification Number, along with notarization by a Florida notary public with seal, notary name, commission expiration date, and confirmation of the contractor's identity through physical presence or online notarization.
This mandatory compliance document is part of Pinellas County's comprehensive procurement requirements for the RRH Program, which includes a total budget of $1,340,000 and a contract term of thirty-six months from award with options for two additional twelve-month renewal periods. Responding organizations must also submit notarized Common Carrier Attestations and Human Trafficking Affidavits, register with the Florida Division of Corporations, maintain specified insurance coverage, and comply with E-Verify requirements. All contractors must adhere to Pinellas County's Standard Terms and Conditions and retain all records for five years after final payment, with the County retaining full monitoring and audit rights.
View the file
Other files
Show 40 more
50 files listed here. See the rest on GovTribe.
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .