Attachment I PUR 1355.docx
DOCX document 18 KB Posted
- Attached to
- Business Automobile Insurance
- Solicitation number
- ITB-13707
- Issued by
- Polk County, Florida
About this file
The document is a Foreign Country of Concern Attestation form (PUR 1355) related to a statewide business automobile insurance contract for the Florida Department of Management Services. The Invitation to Bid (ITB) seeks to establish a one-year State Term Contract effective October 1, 2025, covering comprehensive automobile insurance for seven state agencies, including the Department of Agriculture and Consumer Services, Department of Children and Families, Department of Financial Services, Department of Health, Florida School for the Deaf and Blind, Department of Highway Safety and Motor Vehicles, and Volunteer Florida. The solicitation covers approximately 617 vehicles across multiple Florida counties, with key procurement dates including a solicitation posting on August 26, 2025, a question submission deadline of September 2, 2025, and a bid submission deadline of September 15, 2025 at 2:00 PM.
The estimated annual spend for the expiring business automobile insurance policy is $1,305,368, though this is not guaranteed as a minimum contract value. Bidders must meet specific qualifications, including holding a valid Florida insurance license, providing a dedicated contract manager, offering toll-free customer service, and ensuring claims are filed and settled in the United States. Vendor requirements include at least 10 years of experience in insurance placement, a current certificate of authority to transact insurance, and quotation documentation from insurers with current AM Best Ratings. The state will consider coverage from admitted, non-admitted, reciprocal insurers, and risk management programs, with the right to make no award if determined to be in its best interest. Mandatory certifications include the PUR 7801 Vendor Certification Form, which requires attestations regarding non-participation in boycotts, E-Verify compliance, and adherence to state vendor lists.
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Text version
Attachment I
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) Page 1 of 1 Rule 60A-1.020, F.A.C.
File details come from the government source that posted it. Updated .