Attachment L.pdf
PDF 107 KB Posted
- Attached to
- RES-Males-24 beds-Moderate Risk-SAOS-MHOS- South
- Solicitation number
- RFP-12286
- Issued by
- Broward County, Florida
About this file
This document is a Foreign Country of Concern Attestation form (PUR 1355) used for state and local government contract opportunities in Florida. The form is required to be completed by an officer or representative of an entity submitting a bid, proposal, or reply to a Governmental Entity that would grant access to an individual's Personal Identifying Information. The attestation requires the entity to declare that they are not owned by the government of a Foreign Country of Concern, not organized under the laws of or having a Principal Place of Business in a Foreign Country of Concern, and that no government of a Foreign Country of Concern has a Controlling Interest in the entity.
The form is designed to comply with Rule 60A-1.020 of the Florida Administrative Code and must be signed under penalties of perjury. It provides a standard template for businesses to affirm their independence from foreign government ownership or control when participating in government contract opportunities. The form includes blank spaces for the entity's representative to provide their printed name, title, signature, and the date of execution, ensuring a formal and legally binding declaration of the entity's status regarding foreign government connections.
View the file
Other files
Show all 12
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
PUR 1355 (10/23) Page 1 of 1 Rule 60A-1.020, F.A.C.
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 .