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
The document is a Foreign Country of Concern Attestation form (PUR 1355) intended for use with government contracts in Florida, specifically related to Rule 60A-1.020, F.A.C. The form requires an officer or representative of an entity submitting a bid, proposal, or entering into a contract with a Governmental Entity to attest that their organization is not owned by, organized under the laws of, or principally located in a Foreign Country of Concern, and that no such government has a controlling interest in the entity.
The attestation is designed to provide assurance that entities seeking to access personal identifying information through government contracts do not have significant ties to countries deemed to be of concern. By signing the document under penalties of perjury, the representative affirms the truthfulness of the statement, which includes providing spaces for printed name, title, signature, and date. This form appears to be part of a broader set of compliance requirements for government contracting, particularly for the Florida Department of Juvenile Justice's mentoring services procurement.
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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 .