10834_Attachment L.pdf
PDF 106 KB Posted
- Attached to
- 10834 - PREV - Mentoring Services
- Solicitation number
- RFP-10478
- Issued by
- Leon County, Florida
About this file
This is a Foreign Country of Concern Attestation form (PUR 1355) required by the Florida Department of Management Services for entities submitting bids, proposals, or replies to government contracts that would grant access to personal identifying information. The form must be completed by an officer or representative of the bidding entity and requires attestation under penalty of perjury that the entity is not owned by, organized under the laws of, or has its principal place of business in a Foreign Country of Concern, and that no Foreign Country of Concern has a controlling interest in the entity.
The form consists of a single-page declaration with spaces for the representative's printed name, title, signature, and date. It references Rule 60A-1.020, F.A.C. for definitions of capitalized terms and is a required attachment for the juvenile delinquency prevention mentoring services contract opportunity being solicited by the Florida Department of Juvenile Justice's Office of Prevention Services.
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Text version
PUR 1355 (10/23) Page 1 of 1 Rule 60A-1.020, F.A.C.
FOREIGN COUNTRY OF CONCERN ATTESTATION
(PUR 1355)
This form must be completed by an officer or representative of an entity submitting a bid, proposal, or reply to, or entering into, renewing, or extending, a contract with a Governmental Entity which would grant the entity access to an individual’s Personal Identifying Information.
Capitalized terms used herein have the definitions ascribed in Rule 60A-1.020, F.A.C.
Name of entity is not owned by the government of a Foreign Country of Concern, is not organized under the laws of nor has its Principal Place of Business in a Foreign Country of Concern, and the government of a Foreign Country of Concern does not have a Controlling Interest in the entity.
Under penalties of perjury, I declare that I have read the foregoing statement and that the facts stated in it are true.
Printed Name:
Title:
Signature: Date:
https://www.flrules.org/gateway/RuleNo.asp?title=GENERAL%20REGULATIONS&ID=60A-1.020
File details come from the government source that posted it. Updated .