Form_5_-_Affidavit_of_Compliance_FS_287.138_&_787.06.pdf
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- Solicitation number
- 26-0082MC
- Issued by
- Lee County, Fort Lauderdale City, Florida
About this file
This is an Affidavit of Compliance form required by the Lee County Port Authority for RFP 26-0082MC, which concerns the Aircraft Rescue and Fire Fighting (ARFF) F3 Foam Transition project. The affidavit serves as a mandatory compliance document that proposers must complete and have notarized before submitting their bids for the transition of ARFF vehicles and equipment from aqueous film-forming foam (AFFF) to synthetic fluorine-free foam (SFFF). The project scope includes removal of AFFF storage tanks and associated piping, draining and removal of AFFF from seven ARFF vehicles, cleaning and rinsing of foam tanks and associated appurtenances, FAA-required testing of ARFF vehicles with SFFF, and disposal of waste materials at both LCPA ARFF Stations located at Page Field (FMY) and Southwest Florida International Airport (RSW).
The affidavit requires the affiant to certify compliance with two Florida Statutes: Section 287.138 regarding foreign entities of concern and Section 787.06 regarding human trafficking and coercion for labor. Under Section 287.138, the proposer must certify that it is not owned by or controlled by a foreign government of concern, including China, Russia, Iran, North Korea, Cuba, Venezuela, or Syria, and that it is not organized under or principally based in any such country. Under Section 787.06, the proposer must certify that it does not use coercion for labor or services. The affidavit must be signed and notarized before a Notary Public and submitted with the proposal response.
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Text version
RFP 26-0082MC: Aircraft Rescue and Fire Fighting (ARFF) F3 Foam Transition
FORM 5: AFFIDAVIT OF COMPLIANCE WITH SECTIONS 287.138 (FOREIGN ENTITIES OF
CONCERN) and 787.06 (HUMAN TRAFFICKING), FLORIDA STATUTES Before me, the undersigned authority, personally appeared _______________________ (Name of Affiant) after being first duly sworn, deposes and says of his/her personal knowledge the following:
1. Affiant is the (Title) of (Business Name) ____________________________________________ which does business in the State of Florida, hereinafter called the “Proposer.”
2. Proposer, pursuant to Section 287.138, Florida Statutes, certifies that (1) Proposer is not owned by a government of a foreign country of concern; (2) a government of a foreign country of concern does not have a “controlling interest” in Proposer, as defined by Section 287.138(1)(a), Florida Statutes; and (3) Proposer is not organized under the law of nor has its principal place of business in a foreign country of concern. For the 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, as defined in Section 287.138(1)(c), Florida Statutes, as amended from time to time.
3. Proposer, pursuant to Section 787.06, Florida Statutes, certifies that Proposer does not use coercion for labor or services as defined in Section 787.06, Florida Statutes, as amended from time to time.
4. This Affidavit is executed by the Proposer in accordance with Section 287.138, Florida Statutes, for the purposes of preventing the Port Authority from entering contracts with foreign entities of concern which would provide proper access to an individual’s personal identifying information.
5. This Affidavit is executed by the Proposer in accordance with Section 787.06, Florida Statutes.
Signed and Delivered on this day of , 20__.
Signature of Affiant
Printed Name
Notary Public
STATE OF _______;
COUNTY OF
The foregoing instrument was signed and acknowledged before me this _______ day of _________________, 20____, by ____________________________________________ by means of � physical presence or � online notarization who produced the following as identification _______________________(type of identification) or is personally known to me.
My Commission Expires ________________ [stamp or seal]
[Signature of Notary Public] [Typed or printed name]
Rev: 7.10.2026 Page 47 of 51
| Affiant after being first duly sworn deposes and says of hisher personal knowledge the following: |
| which does business in the State of: |
| Florida hereinafter called the Proposer: |
| day of: |
| 20: |
| Printed Name: |
| COUNTY OF: |
| foregoing: |
| by means of: |
| undefined: |
| or: |
| online: |
| My Commission Expires: |
| type of identification or is personally known to me: |
| Typed or printed name: |
| Text3: |
| Check Box4: Off |
| Check Box5: Off |
File details come from the government source that posted it. Updated .