FORM 12-PUR 1355-FOREIGN COUNTRY OF CONCERN ATTESTATION.pdf

This is a Foreign Country of Concern Attestation form (PUR 1355) issued by the State of Florida Department of Management Services for ITN No. DMS-26/27-025 related to MyFloridaNetwork-3. 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 requires the bidder to certify 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 a Foreign Country of Concern, does not have 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 the signing officer or representative to provide their printed name, title, signature, and date. Capitalized terms used in the attestation are defined in Rule 60A-1.020, F.A.C. This attestation is a prerequisite compliance document and does not contain pricing information, set-asides, incumbent contractor details, or funding requirements. The form serves as a security and ownership verification measure for contracts involving access to personal identifying information.