3-Attachment E-Foreign Country of Concern.pdf

This is a Foreign Country of Concern Attestation form (PUR 1355) required by the State of Florida for entities bidding on the Halifax Behavioral Services Unit 200 Remediation project with Halifax Health. The attestation must be completed by an officer or representative of any bidder seeking to access Personal Identifying Information through a contract with a governmental entity. The form requires the bidder to declare under penalties 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 the government of a Foreign Country of Concern does not hold a Controlling Interest in the entity.

Bidders must complete the form by providing the entity name, printed name and title of the signatory, signature, and date. The attestation is governed by Rule 60A-1.020, F.A.C., and the form references capitalized terms defined within that rule. Completion of this attestation is mandatory for participation in the Halifax Behavioral Services remediation bid and serves as a compliance and eligibility verification requirement for contract award consideration.