Local_Vendor_Affidavit.pdf
PDF 129 KB Posted
- Solicitation number
- 26-RFP-003
- Issued by
- Glades County, Brownsville CDP, Florida
About this file
This is a Local Vendor Affidavit form used by Flagler County, Florida in conjunction with its Tourism Website Design, Development & Maintenance procurement. The affidavit enables vendors and individuals to formally request local vendor preference consideration in accordance with Section 17 of the Flagler County Procurement Manual. The form requires the submission of sworn statements that include the vendor's name, authorized representative information, business address, and Federal Employer Identification Number or Social Security Number. Vendors must indicate whether they are requesting local vendor preference through a checkbox on the document.
The affidavit requires notarization to authenticate the vendor's identity and the truthfulness of the submitted information. Authorized company representatives must sign the document, which must then be acknowledged before a notary public who verifies the signatory's identity through personal knowledge or valid identification. The notary must complete their section with the date, notary commission expiration date, and commission number. This documentation serves as a formal mechanism for Flagler County to verify vendor eligibility for local preference considerations during the procurement process for the tourism website project.
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Text version
LOCAL VENDOR AFFIDAVIT (If Applicable)
1. This sworn statement is submitted to ____________________________________________________________
By: _____________________________________________________________________________________ [Print individual's name and title]
For: _________________________________________________________________________________________ [Print name of Company/Individual submitting sworn statement]
Whose business address is _______________________________________________________________________
(If applicable) its Federal Employer Identification Number (FEIN) is __________ (If the entity has no FEIN, include the Social Security Number of the individual signing this Sworn statement) : ______________________________
Please check yes if Vendor/Individual is requesting Local Vendor Preference per Section 17 of the Flagler County Procurement Manual
YES ______
(Authorized Signature) (Date)
(Print Name)
STATE OF ___________
COUNTY OF ___________________________
The foregoing instrument was acknowledged before me _____ day of ___________________________, 20_____, by
__________________________________________, who is personally known to me or who has produced
____________________________ as identification.
Notary Public
My Commission Expires: ____________________ Commission #_________
*NOTICE: State name of Offeror followed by name of authorized individual (and title) that is signing as Affiant. If Offeror is an individual, state name of Offeror only.
File details come from the government source that posted it. Updated .