Att_L_Foreign_Country_Attestation_.pdf
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- Attached to
- RFP#10769 – Aftercare Resource Navigator Program
- Solicitation number
- RFP-10627
- Issued by
- Leon County, Florida
About this file
This is a Foreign Country of Concern Attestation form (PUR 1355) required by the Florida Department of Management Services for entities submitting bids, proposals, or replies to contracts with Governmental Entities that would grant access to personal identifying information. The form, governed by Rule 60A-1.020, F.A.C., must be completed by an officer or representative of the bidding entity.
The attestation requires the signing entity to declare under penalty of perjury that they are not owned by the government of a Foreign Country of Concern, are not organized under such laws, do not have their principal place of business in such a country, and that no Foreign Country of Concern has a controlling interest in their entity. The form requires the official's printed name, title, signature, and date.
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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
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