5-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 contracts with governmental entities that would provide access to Personal Identifying Information. The form applies to the Halifax Health procurement for a Haag-Streit BQ 900 LED Slit Lamp with Imaging. The attestation requires an authorized officer or representative of the bidding entity to certify under penalty of perjury that the entity is not owned by, organized under the laws of, or located in a Foreign Country of Concern, and that no foreign government of concern maintains a controlling interest in the entity. The form must be completed and signed with the entity name, officer printed name and title, signature, and date.

This attestation is a mandatory compliance document based on Rule 60A-1.020, F.A.C., and serves as a security and ownership verification mechanism for the State of Florida. All bidders submitting proposals for this Halifax Health equipment procurement must complete and submit this form as part of their bid package to demonstrate they meet the foreign ownership and control requirements established by Florida law.