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 a contract with Halifax Health to provide security equipment installation services at the Charles L and Miki N Grant Cancer Center for Hope. The attestation pertains to a project scope that includes installing badge readers, cameras, j-hooks, performing patch and paint work, ensuring ICRA compliance, and applying fire sealant to penetrations in an active healthcare facility. The contract opportunity requires qualified contractors with demonstrated experience working in operational healthcare environments where patient care continues during construction activities.

The attestation form mandates that bidding entities declare under penalties of perjury that they are not owned by, organized under the laws of, nor have their principal place of business in a Foreign Country of Concern, and that no Foreign Country of Concern government holds a controlling interest in the entity. This declaration must be completed and signed by an officer or representative of the bidding entity. The form applies to any entity seeking to enter into, renew, or extend a contract with a Governmental Entity that would grant access to personal identifying information, as defined in Florida Administrative Code Rule 60A-1.020.