Attachment K, PUR 1355 Foreign Country of Concern Attestation.docx

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Attached to
Mail Services
Solicitation number
RFP-10992
Issued by
Florida

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This document is an Attachment K Foreign Country of Concern Attestation form required for a state or local government contract opportunity. The attestation must be completed by an entity submitting a bid, proposal, or reply, or entering into, renewing, or extending a contract with a Governmental Entity that would grant the entity access to an individual's Personal Identifying Information. The entity must attest that it 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.

The document provides the exact language that must be attested to under penalties of perjury, requiring the printed name, title, signature, and date of an authorized representative of the entity. This attestation is required under Rule 60A-1.020, F.A.C. for the specified contract opportunity.

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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: ___________________

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 .