Attachment L, PUR1355 Foreign Country of Concern Attestation.pdf

This document is a Foreign Country of Concern Attestation form (PUR 1355) required by the State of Florida under Rule 60A-1.020, F.A.C. The form must be completed by an officer or representative of any entity submitting a bid, proposal, or reply to, 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 attestation applies to all contract scenarios regardless of contract type, duration, or value.

The attestation requires the signing entity to declare under penalties of perjury that the 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 that the government of a Foreign Country of Concern does not have a Controlling Interest in the entity. The form requires completion of three fields: Printed Name, Title, Signature, and Date. Capitalized terms used in the attestation are defined in Rule 60A-1.020, F.A.C., and the form is referenced as Attachment L in procurement documents. The form version is dated 10/23 and is one page in length.