4-Attachment E-Foreign Country of Concern.pdf

This is a Foreign Country of Concern Attestation form (PUR 1355) required by the State of Florida for entities submitting bids or proposals to Halifax Health for architectural and engineering design services related to the renovation of Suites 200 and 205/210 in the Halifax Health 201 Building. The attestation must be completed by an 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 declare under penalties of perjury that the entity is not owned by, organized under the laws of, or has its 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 form must be signed, dated, and include the printed name and title of the authorized representative. Capitalized terms referenced in the form are defined in Rule 60A-1.020, Florida Administrative Code. This certification is a mandatory compliance requirement for contract eligibility and represents a critical component of Florida's procurement process designed to ensure entities handling sensitive government information meet specified foreign ownership and control restrictions.