19-Foreign Country of Concern Attestation (PII).docx
DOCX document 36 KB Posted
- Attached to
- Group Long Term Disability Insurance
- Solicitation number
- GEN2129113P1
- Issued by
- Broward County, Florida
About this file
This document is a Foreign Country of Concern Attestation form for Broward County, Florida, specifically related to a Group Long Term Disability Insurance solicitation. The procurement seeks a qualified firm to provide Group Long Term Disability Insurance, including enrollment support and administration services for benefit-eligible employees. The solicitation requires electronic submission through BPRO (Broward County's procurement system), with vendors responsible for ensuring timely and complete electronic submission. Vendors must complete the attestation form confirming they are not owned by, organized under the laws of, or controlled by a Foreign Country of Concern.
The solicitation includes several key requirements, such as completing an ETS Vendor Security Questionnaire and adhering to the Office of Economic and Small Business Development's procurement preferences for Small Business Enterprises and County Business Enterprises. Vendors are required to submit questions through BPRO by a specified date and will receive responses in the system's Messages section. The project is associated with Broward County's Project Specific Agreement (GEN2129113P1), and vendors must carefully review the full solicitation documents to ensure complete compliance with all stated requirements and specifications.
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Text version
FOREIGN COUNTRY OF CONCERN ATTESTATION
(for Contracts giving access to an individual’s personal identifying information)
The completed form should be returned with the Vendor’s submittal. If not provided with the submittal, Vendor must submit the form(s) within three business days after County’s request and no later than entering, renewing, or extending, a contract with Broward County. Vendor may be deemed nonresponsive for failure to fully comply within the stated timeframe.
Capitalized terms used herein have the definitions ascribed in Rule 60A-1.020, F.A.C.
Vendor 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.
Vendor Name: Click or tap here to enter text.
Signature: ______________________________ Printed Name: Click or tap here to enter text.
Title: Click or tap here to enter text.
Date: Click or tap to enter a date.
Form Date 9/9/24
File details come from the government source that posted it. Updated .