3-Attachment E-Foreign Country of Concern.pdf

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Attached to
1st Floor Pharmacy Renovation
Solicitation number
PROJ-25-098
Issued by
Volusia County, Florida

About this file

This is a Foreign Country of Concern Attestation form (PUR 1355) required by Florida Administrative Code Rule 60A-1.020, F.A.C., that must be completed by officers or representatives of entities submitting bids, proposals, or replies to governmental contracts that would provide access to individuals' Personal Identifying Information. The form serves as Attachment E to procurement documents and requires entities to attest that they are not owned by, organized under the laws of, or have their principal place of business in a Foreign Country of Concern, and that no Foreign Country of Concern government has a controlling interest in the entity.

The attestation must be completed under penalties of perjury and requires the printed name, title, signature, and date from an authorized representative of the bidding entity. The form is dated October 2023 and references the specific Florida Administrative Code rule that defines the capitalized terms used throughout the document. This requirement appears to be a standard compliance measure for Florida governmental entities to ensure that contractors with access to personal identifying information do not have concerning foreign government connections.

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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 .