FORM 12-PUR 1355 FOREIGN COUNTRY OF CONCERN ATTESTATION.pdf
PDF 238 KB Posted
- Attached to
- MyFloridaNet-3 Core Services - ITN
- Solicitation number
- ITN-12980
- Issued by
- Clay County, Leon County, Polk County, Florida
About this file
This document is a Foreign Country of Concern Attestation form (Form 12 - PUR 1355) issued by the Florida Department of Management Services for the MyFloridaNetwork-3 Core Services Invitation to Negotiate (ITN No.: DMS-24/25-260). The form is a mandatory attestation required for entities submitting bids, proposals, or entering into contracts with governmental entities that would provide access to personal identifying information.
The attestation requires an officer or representative of the bidding entity to declare under penalties of perjury that their organization is not owned by, organized under the laws of, or having a principal place of business in a "Foreign Country of Concern," and that no such foreign government has a controlling interest in the entity. The form must be signed and dated by an authorized representative, with blank fields provided for the printed name, title, signature, and date of execution. This requirement appears to be a security measure to protect sensitive government information and infrastructure from potential foreign influence or control.
View the file
Other files
Show all 49
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
ITN No.: DMS-24/25-260 Page 1 of 2 MyFloridaNet-3 Core Services
FORM 12 – PUR 1355 FOREIGN COUNTRY OF CONCERN ATTESTATION
4050 Esplanade Way Tallahassee, FL 32399-0950
850-488-2786
Ron DeSantis, Governor Pedro Allende, Secretary
FORM 12 – PUR 1355 FOREIGN COUNTRY OF CONCERN ATTESTATION
FOR
MyFloridaNetwork-3
ITN NO: DMS-24/25-260
THE STATE OF FLORIDA
DEPARTMENT OF MANAGEMENT SERVICES
ITN No.: DMS-24/25-260 Page 2 of 2 MyFloridaNet-3 Core Services
FORM 12 – FOREIGN COUNTRY OF CONCERN ATTESTATION
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 .