3-Attachment E-Foreign Country of Concern.pdf

809 KB Posted

Attached to
FIRE PUMP
Solicitation number
PROJ-26-010
Issued by
Volusia County, Florida

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This document is a Foreign Country of Concern Attestation form (PUR 1355) associated with a governmental procurement process, specifically related to Rule 60A-1.020, F.A.C. The form requires an officer or representative of an entity submitting a bid, proposal, or entering into a contract with a Governmental Entity to attest that their organization is not owned, organized, or controlled by the government of a Foreign Country of Concern.

The attestation requires the entity's representative to declare under penalties of perjury that their organization meets specific criteria regarding foreign ownership and control. This includes confirming that the entity is not owned by a foreign government, 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 no foreign government has a Controlling Interest in the entity. The form provides spaces for the representative's printed name, title, signature, and the date of signing.

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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 .