3-Attachment E-Foreign Country of Concern.pdf

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Attached to
France Tower Lobby Area Window Tint
Solicitation number
PROJ-25-132
Issued by
Volusia County, Florida

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This is a Foreign Country of Concern Attestation form (PUR 1355) that must be completed by entities bidding on or contracting with Florida governmental entities. The form is required for any entity submitting a bid, proposal, or reply to, or entering into, renewing, or extending a contract with a governmental entity that would grant access to an individual's Personal Identifying Information. The form references Rule 60A-1.020, F.A.C. for definitions of capitalized terms used throughout the document.

The attestation requires an officer or representative of the entity to declare under penalties of perjury that their organization is not owned by the government of a Foreign Country of Concern, is not organized under the laws of or headquartered in a Foreign Country of Concern, and that no Foreign Country of Concern government has a controlling interest in the entity. The form includes fields for the signatory's printed name, title, signature, and date, and was last updated in October 2023 (10/23).

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Attachment E

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: __________

PUR 1355 (10/23) Rule 60A-1.020, F.A.C.

PUR 1355 1023:
Rule 60A1020 FAC:
Text1:
Text3:
Text4:

File details come from the government source that posted it. Updated .