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) related to a governmental procurement process governed 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 with a Governmental Entity where the entity would be granted access to an individual's Personal Identifying Information.

The attestation requires the entity to declare that it is not owned by the government of a Foreign Country of Concern, is not organized under the laws of or have its Principal Place of Business in a Foreign Country of Concern, and that the government of a Foreign Country of Concern does not have a Controlling Interest in the entity. The form must be signed under penalties of perjury, with the signatory affirming the truthfulness of the statement by providing their printed name, title, signature, and date of execution.

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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

File details come from the government source that posted it. Updated .