3-Attachment E-Foreign Country of Concern.pdf

809 KB Posted

Attached to
Port Orange SPD Equipment Replacement
Solicitation number
PROJ-25-136
Issued by
Volusia County, Florida

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This document is a Foreign Country of Concern Attestation form (PUR 1355) for a governmental entity procurement process in Florida, as indicated by the reference to Rule 60A-1.020, F.A.C. The form is designed to be completed by an officer or representative of an entity submitting a bid, proposal, or entering into a contract that would provide access to an individual's Personal Identifying Information.

The attestation requires the entity to declare that it is not owned by the government of a Foreign Country of Concern, not organized under such a country's laws, does not have its Principal Place of Business in a Foreign Country of Concern, and that no government of a Foreign Country of Concern has a Controlling Interest in the entity. The form must be signed under penalties of perjury, with spaces provided for the printed name, title, signature, and date of the authorized representative completing the attestation.

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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 .