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ATTACHMENT F <br />FOREIGN COUNTRY OF CONCERN AFFIDAVIT — <br />PERSONAL IDENTIFYING INFORMATION CONTRACT <br />Section 287.138, Florida Statutes, prohibits a Florida "Governmental entity"' from entering into or <br />extending contracts with any other entity whereby such a contract, or extension thereof, could grant the <br />other entity access to an individual's personal identifying information if that entity is associated with a <br />"Foreign Country of Concern."z Specifically, section 287.138(2), Florida Statutes, prohibits such <br />contracts with any entity that is owned by the government of a Foreign Country of Concern, any entity <br />in which the government of a Foreign Country of Concern has a "controlling interest," 3 and any entity <br />organized under the laws of or which has its principal place of business in a Foreign Country of Concern. <br />As the person authorized to sign on behalf of Recipient, I hereby attest that the company identified <br />below in the section entitled "Recipient" is not an entity owned by the government of a Foreign Country <br />of Concern, no government of a Foreign Country of Concern has a controlling interest in the entity, and <br />the entity has not been organized under the laws of or has its principal place of business in a Foreign <br />Country of Concern. <br />I understand that pursuant to section 287.138, Florida Statutes, I am submitting this affidavit under <br />penalty of perjury. <br />Recipient Name: <br />Recipient FEIN: <br />Recipient's Authorized Representative Name and Title: <br />Address: <br />City: <br />Phone Number: <br />Email Address: <br />Certified By: <br />AUTHORIZED SIGNATURE <br />Print Name and Title: <br />Date: <br />State: Zip: <br />' As defined in Section 287.138 (1)(d), Florida Statutes. <br />2 As defined in Section 287.138 (1)(c), Florida StatuN. <br />3 As defined in Section 287.138 (1)(a), Florida Statutes. <br />155 <br />