5-Attachment E-Foreign Country of Concern.pdf

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Attached to
Water Heater for SEVCC
Solicitation number
PROJ-25-149
Issued by
Volusia County, Florida

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Attachment E is a Foreign Country of Concern Attestation form (PUR 1355) used by governmental entities in Florida, as referenced by Rule 60A-1.020, F.A.C. The form is designed to be completed by an officer or representative of an entity submitting a bid, proposal, or entering into a contract with a governmental entity that would involve access to an individual's Personal Identifying Information.

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 or 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 under penalties of perjury, with space provided for the printed name, title, signature, and date of the attesting official, ensuring transparency and accountability in governmental contracting processes.

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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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File details come from the government source that posted it. Updated .