3-Attachment E-Foreign Country of Concern.pdf
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- Attached to
- 200 TON ROOM BOOSTER PUMP
- Solicitation number
- PROJ-26-067
- Issued by
- Volusia County, Florida
About this file
This is a Foreign Country of Concern Attestation form (PUR 1355) required by Florida for entities submitting bids or proposals to Halifax Health for a 200 ton room booster pump removal and replacement project. The attestation must be completed by an authorized officer or representative of any bidding entity that would be granted access to personal identifying information as part of the contract. The form requires the bidder to certify under penalties of perjury that the entity is not owned by a foreign government 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 is not controlled by a foreign government of concern, as defined in Florida Administrative Code Rule 60A-1.020.
Bidders must complete the form by providing the entity name, printed name and title of the certifying officer or representative, signature, and date. This certification is a mandatory compliance requirement for contract award and reflects Florida's security and integrity standards for protecting sensitive personal information in state and local government contracts.
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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: |
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