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 Halifax Health's First Floor Service Building Insulation Replacement contract opportunity. The attestation must be completed by an officer or representative of any entity submitting a bid, proposal, 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 requires the bidding entity to certify under penalties of perjury that it is not owned by the government of a Foreign Country of Concern, is not organized under the laws of a Foreign Country of Concern, does not have its Principal Place of Business in a Foreign Country of Concern, and that the government of a Foreign Country of Concern does not have a controlling interest in the entity.

The attestation form requires completion of specific fields including the name of the entity, printed name of the signatory, title, signature, and date. This certification is governed by Rule 60A-1.020, F.A.C., and represents a standard compliance requirement for state and local contract opportunities in Florida involving access to personal identifying information.