Attachment L, PUR1355 Foreign Country of Concern Attestation.pdf

229 KB Posted

Attached to
Natural Gas Supply ITB
Solicitation number
ITB-13699
Issued by
Leon County, Florida

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This document is a Foreign Country of Concern Attestation form (PUR 1355) from the Florida Administrative Code (Rule 60A-1.020, F.A.C.), designed for entities submitting bids, proposals, or contracts with governmental entities that would provide access to personal identifying information. The form requires an officer or representative to certify that their organization is not owned by, organized under the laws of, or principally located in a Foreign Country of Concern, and that such a government does not have a controlling interest in the entity.

The attestation form is a standard compliance document that requires the signatory to declare under penalties of perjury that the statements made are true. The form includes blank fields for the printed name, title, signature, and date of the authorized representative, and is part of a broader governmental procurement process aimed at ensuring transparency and security in contracting with entities that might have foreign government connections.

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PUR 1355 (10/23) Page 1 of 1 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:

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.

Attachment L 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 .