Attachment K, Form PUR 1355 Foreign Country of Concern Attestation Form.pdf

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Attached to
Firearms and Related Accessories ITB
Solicitation number
ITB-13527
Issued by
Florida

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This document is a Foreign Country of Concern Attestation form (PUR 1355) used by governmental entities in Florida, as referenced by Rule 60A-1.020, F.A.C. The form is designed to be completed by an officer or representative of an entity submitting a bid, proposal, or contract to a governmental entity where the contract would provide access to Personal Identifying Information. The attestation requires the entity to confirm that it is not owned by, organized under the laws of, or principally located in a "Foreign Country of Concern," and that such a foreign government does not have a controlling interest in the entity.

The form is a legal declaration made under penalties of perjury, requiring the entity's representative to sign and date the document, affirming the truthfulness of the statements made. By completing this form, the entity is providing assurance to the governmental body that it does not have significant foreign governmental connections that might pose a potential security or privacy risk, particularly in contracts involving sensitive personal information.

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PUR 1355 (10/23) Page 1 of 1 Rule 60A-1.020, F.A.C.

Attachment K

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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