Att_L_Foreign_Country_Attestation_.pdf
PDF 106 KB Posted
- Attached to
- RFP#10769 – Aftercare Resource Navigator Program
- Solicitation number
- RFP-10627
- Issued by
- Leon County, Florida
About this file
This document is Form PUR 1355, a Foreign Country of Concern Attestation form required by the Florida Department of Juvenile Justice for RFP#10769 – Aftercare Resource Navigator Program. The form must be completed by any officer or representative of an entity submitting a bid, proposal, or reply, or entering into, renewing, or extending a contract with a Governmental Entity that would grant access to personal identifying information.
The form requires the submitting entity to attest that it is not owned by, organized under the laws of, or has its principal place of business in a Foreign Country of Concern. Additionally, it confirms that no government of a Foreign Country of Concern has a controlling interest in the entity. The document includes spaces for the representative's printed name, title, signature, and date, and must be signed under penalties of perjury according to Rule 60A-1.020, F.A.C.
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Text version
PUR 1355 (10/23) Page 1 of 1 Rule 60A-1.020, F.A.C.
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:
https://www.flrules.org/gateway/RuleNo.asp?title=GENERAL%20REGULATIONS&ID=60A-1.020
File details come from the government source that posted it. Updated .