3-Attachment E-Foreign Country of Concern.pdf

This file is a Foreign Country of Concern Attestation form (PUR 1355) required by the State of Florida for the Port Orange Freestanding Emergency Department Irrigation project administered by Halifax Health. The attestation must be completed by an officer or representative of 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 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 must be signed by an authorized officer or representative of the bidding entity and includes fields for the printed name, title, signature, and date of the signatory. This certification is a compliance requirement under Rule 60A-1.020, Florida Administrative Code, and all qualified contractors submitting proposals for the irrigation system installation project must complete and submit this form as part of their bid package.