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 bidding on or entering into contracts with governmental entities that would provide access to Personal Identifying Information. The attestation applies to the Halifax Health History Wall project, which seeks qualified vendors to develop the concept, design, fabricate, and install a museum-quality static history wall commemorating Halifax Health's 100-year anniversary. The form must be completed and signed under penalties of perjury by an officer or representative of the bidding entity.

The attestation requires the entity to declare 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 hold a Controlling Interest in the entity. As defined in Rule 60A-1.020, F.A.C., this certification is mandatory for contract award consideration and protects the state's interests regarding access to sensitive personal information and national security concerns.