Attachment M, PUR 1355 Foreign Country of Concern Attestation.pdf
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- Attached to
- Agriculture and Lawn Equipment ITB-V2
- Solicitation number
- ITB-17042
- Issued by
- Florida
About this file
This is a Foreign Country of Concern Attestation form (PUR 1355) required by the State of Florida, Department of Management Services, for the Agriculture and Lawn Equipment Invitational Travel Bid (ITB-V2) solicitation. The form must be completed and signed by an officer or representative of any entity submitting a bid or proposal that would grant access to an individual's Personal Identifying Information. The attestation certifies that the bidding entity is not owned by the government of a Foreign Country of Concern, is not organized under the laws of a Foreign Country of Concern, does not have its Principal Place of Business in a Foreign Country of Concern, and that no Foreign Country of Concern has a Controlling Interest in the entity. The form requires the signatory to declare under penalties of perjury that the statements are true and accurate.
The Department of Management Services is issuing this ITB to establish a statewide term contract for agriculture and lawn equipment, with the intent to make multiple awards, though the Department reserves the right to award to one or multiple 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 for procurement updates. The procurement officer is Chris Molina, Purchasing Analyst, who can be reached at (850) 921-0030 or Christopher.Molina@dms.fl.gov. Any protests must be filed within the timeframe prescribed under Florida Statutes Section 120.57(3) with the Department of Management Services, Office of the General Counsel.
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Text version
PUR 1355 (10/23) Page 1 of 1 Rule 60A-1.020, F.A.C.
ATTACHMENT M
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
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