5-Attachment E-Foreign Country of Concern.pdf
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- Attached to
- REVERSE OSMOSIS SYSTEM REPLACEMENT FOR TLSC SPD
- Solicitation number
- PROJ-25-163
- Issued by
- Volusia County, Florida
About this file
This document is a Foreign Country of Concern Attestation form (PUR 1355) for governmental entities in Florida, governed by Rule 60A-1.020, F.A.C. The form requires an officer or representative of an entity submitting a bid, proposal, or entering into a contract with a governmental entity to attest that their organization is not owned by, organized under the laws of, or has a controlling interest from a Foreign Country of Concern.
The attestation specifically requires the entity to declare, under penalties of perjury, that they do not have connections to a Foreign Country of Concern that would compromise their business integrity or potential access to Personal Identifying Information. The form includes signature lines for printed name, title, signature, and date, allowing the authorized representative to formally certify the organization's independence and compliance with the specified requirements.
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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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