Foreign_Countries_of_Concern_Affidavit.pdf
PDF 200 KB Posted
- Attached to
- 26-0180-RFP Banking Services (Board and Clerk)
- Solicitation number
- 26-0180-REQ
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This is a Foreign Countries of Concern Affidavit required by Pinellas County, Florida for the Banking Services (Board and Clerk) RFP (26-0180-RFP). The affidavit applies to any contractor submitting a bid or proposal to provide comprehensive banking services to the Pinellas County Board of County Commissioners and the Pinellas County Clerk of the Circuit Court and Comptroller, particularly those that would grant access to personal identifying information. Contractors must certify compliance with Section 287.138, Florida Statutes, confirming that the entity is not owned by or controlled by a Foreign Country of Concern and is not organized under the laws of or principally located in such a country.
For purposes of this affidavit, a "Foreign Country of Concern" includes 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 possession of power to direct management or policies of a company, including direct or indirect ownership of 25 percent or more of voting interests or entitlement to 25 percent or more of profits. The affidavit must be completed and signed by an authorized representative of the contractor under penalties of perjury and notarized before a notary public, with the notarization conducted either in physical presence or via online notarization.
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Text version
Foreign Countries 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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