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 RFP (26-0180) directed at the Pinellas County Board of County Commissioners and the Pinellas County Clerk of the Circuit Court and Comptroller. The affidavit must be completed and notarized by an authorized representative of any contractor submitting a bid or proposal for a contract that would grant the entity access to Personal Identifying Information. The document certifies that the contractor is not owned by, does not have a controlling interest held by, and is not organized under the laws of or principally located in a Foreign Country of Concern, defined as 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. The affidavit establishes that a controlling interest is presumed when a person or entity directly or indirectly possesses the right to vote 25 percent or more of voting interests or is entitled to 25 percent or more of profits.
The affidavit requires the contractor's authorized representative to sign under penalties of perjury, provide their printed name and date, supply their Federal Work Authorization User Identification Number, and identify the Pinellas County Contract and Contract Number. The document must be acknowledged before a notary public through either physical presence or online notarization, with the notary providing their seal, printed name, and commission expiration date. This compliance requirement reflects Pinellas County's commitment to ensuring that banking service providers meet security and ownership criteria aligned with Florida Statutes Section 287.138.
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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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