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 Halifax Health's compact utility tractor procurement. The attestation must be completed by an officer or representative of any entity submitting a bid or proposal for this contract, which would grant access to an individual's Personal Identifying Information. The form requires the bidding entity to certify under penalties of perjury that it is not owned by the government of a Foreign Country 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 that the government of a Foreign Country of Concern does not have a Controlling Interest in the entity. The form must be signed and dated by an authorized officer or representative with printed name and title clearly indicated.

This attestation is governed by Rule 60A-1.020, Florida Administrative Code, and serves as a compliance document necessary for contract execution. All bidders responding to Halifax Health's request for a replacement compact utility tractor with factory-installed loader, single point hydraulic coupler, bucket, specified tires, warranties, and delivery must complete and submit this form as part of their proposal package. Failure to provide this certification or providing false information subjects the bidder to perjury penalties under Florida law.