4-Attachment E-Foreign Country of Concern.pdf

This is a Foreign Country of Concern Attestation form (PUR 1355) required by Halifax Health, a Florida governmental entity, for entities seeking to enter into or renew a contract that would grant access to individuals' Personal Identifying Information. The attestation must be completed and signed by an officer or representative of any bidding entity and certifies, under penalties of perjury, that the entity 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 requires the printed name, title, signature, and date of the authorized representative.

This attestation is a compliance requirement for the valet parking services contract opportunity at Halifax Medical Center, where Halifax Health is soliciting qualified valet parking firms to provide complimentary valet parking services for patients and visitors. The completion and submission of this form is mandatory for any entity responding to this contract opportunity in Florida, as it serves as a safeguard to ensure that contractors handling Personal Identifying Information are not subject to foreign government control or influence.