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
The document is a Foreign Country of Concern Attestation (PUR 1355) form issued under Rule 60A-1.020, F.A.C., designed for entities submitting bids, proposals, or entering into contracts with governmental entities that would grant access to Personal Identifying Information. The form requires an officer or representative to attest that their organization is not owned by, organized under the laws of, or principally located in a Foreign Country of Concern, and that no such government has a controlling interest in the entity.
The attestation must be signed under penalties of perjury, with the signatory declaring the truthfulness of the statement. The form provides spaces for the printed name, title, signature, and date of the attesting individual. This document appears to be a standard compliance form aimed at ensuring that contractors do not have significant ties to countries deemed to be of concern from a national security or regulatory perspective.
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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 .