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
About this file
This document is a Foreign Country of Concern Attestation form (PUR 1355) issued under Rule 60A-1.020, F.A.C., designed for entities submitting bids, proposals, or entering contracts with governmental entities where personal identifying information access may be granted. The form requires an authorized representative to declare that their organization 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 hold a controlling interest in the entity.
The attestation must be signed under penalties of perjury, with the signatory affirming the truthfulness of the statement. The form provides space for the entity's name, the printed name and title of the authorized representative, their signature, and the date of execution. While the document does not specify a particular contract or procurement, it appears to be a standard compliance document intended to protect governmental interests by ensuring contractors do not have significant foreign government connections that could potentially compromise sensitive information.
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Text version
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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