3-Attachment E-Foreign Country of Concern.pdf

This is a Foreign Country of Concern Attestation form (PUR 1355) required by Halifax Health, a governmental entity in Florida, for entities submitting bids, proposals, or replies to contracts that would grant access to personal identifying information. The attestation applies to the PO ROC RTU #3 Replacement contract opportunity, which involves replacing one rooftop unit (RTU) at Halifax Health Port Orange Cancer Center. Any entity bidding on this contract must complete and sign this form, certifying under penalties of perjury that the entity is not owned by, organized under the laws of, does not have its principal place of business in, and does not have a controlling interest held by the government of a Foreign Country of Concern as defined in Florida Administrative Code Rule 60A-1.020.

The form requires completion by an authorized officer or representative of the bidding entity and must include the entity's printed name, the signatory's title, signature, and date. This attestation is a compliance requirement for contract eligibility and must be submitted as part of the bid package for the RTU replacement project at the Port Orange Cancer Center facility.