16-Foreign Country of Concern Attestation (PII).docx

This is a Foreign Country of Concern Attestation form required by Broward County, Florida for vendors seeking contracts that provide access to personal identifying information. The attestation requires vendors to certify under penalty of perjury that they are not owned by a foreign country of concern, are not organized under the laws of a foreign country of concern, do not maintain their principal place of business in a foreign country of concern, and that no foreign country of concern maintains a controlling interest in their entity. The completed form must be submitted with the vendor's proposal at the time of submittal. If the form is not provided initially, vendors must submit it within three business days of the County's request and no later than entering, renewing, or extending any contract with Broward County. The form requires the vendor's name, authorized signatory's signature and printed name, title, and date, with all capitalized terms defined in Rule 60A-1.020 of the Florida Administrative Code.

Failure to fully comply with the attestation requirements within the stated timeframe may result in a vendor being deemed nonresponsive and potentially ineligible for contract award. This requirement applies specifically to the Risk Management and Claims Administration System contract opportunity (Reference BLD2131488P1), a turnkey Risk Management Information System project with proposals due November 13, 2026, that will track claim costs, deadlines, documents, dispositions, and related data with integration to the County's Third-Party Administrators' systems. The contract structure includes a five-year initial term with five one-year renewal options.