5-Attachment E-Foreign Country of Concern.pdf
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- Attached to
- HOSPITAL GRADE – UV - C
- Solicitation number
- PROJ-25-130
- Issued by
- Volusia County, Florida
About this file
This file is Attachment E, a Foreign Country of Concern Attestation form (PUR 1355) required by governmental entities in Florida for contracts involving access to Personal Identifying Information. The form must be completed by an officer or representative of any entity submitting bids, proposals, or replies to, or entering into, renewing, or extending contracts with governmental entities. The form is governed by Rule 60A-1.020 of the Florida Administrative Code and requires entities to attest under penalties of perjury that they meet specific requirements regarding foreign ownership and control.
The attestation specifically requires entities to certify that they are not owned by the government of a Foreign Country of Concern, are not organized under the laws of or have their 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 includes signature fields for printed name, title, signature, and date, and the current version is dated October 2023. This attestation appears to be a standard requirement for contracts where vendors would have access to personal identifying information as part of their service delivery.
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Text version
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.
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