Attachment L - PUR 1355 Foreign Country of Concern Attestation Form.pdf

This is a Foreign Country of Concern Attestation Form (PUR 1355) required by the State of Florida, Department of Management Services, for vendors submitting bids or proposals to state contracts that would provide access to personal identifying information. The form applies to the Motor Vehicles Invitational to Bid (ITB) issued by the Department of Management Services to establish a statewide state term contract for motor vehicles, with the intent to make multiple awards to one or more bidders on a statewide or regional basis. Interested vendors must submit responses through the MyFloridaMarketPlace Sourcing Event via the SAP Business Network and monitor the Vendor Information Portal (VIP) throughout the procurement process. The procurement officer is Chelsea Johnson, Senior Purchasing Analyst, at the Division of State Purchasing, Florida Department of Management Services, located in Tallahassee, Florida.

The attestation form must be completed by an authorized officer or representative of the bidding entity and requires certification under penalties of perjury that the entity is not owned by, organized under the laws of, does not have its principal place of business in, and is not controlled by the government of a Foreign Country of Concern, as defined in Rule 60A-1.020, Florida Administrative Code. The form requires the entity name, signatory's printed name and title, signature, and date. Any protest concerning the agency's decision must be timely filed with the Agency Clerk within the timeframe prescribed in section 120.57(3), Florida Statutes, in accordance with chapter 120, Florida Statutes.