Form 3 - Foreign Countries of Concern.docx
DOCX document 31 KB Posted
- Attached to
- Emergency Fuels State and local contract opportunity
- Solicitation number
- RFP-12351
- Issued by
- Leon County, Florida
About this file
This document is a Form 3 Foreign Countries of Concern Attestation form designed for use in Florida government contracting, specifically related to Rule 60A-1.020, F.A.C. The form requires an officer or representative of an entity submitting a bid, proposal, or entering into a contract with a governmental entity to certify that their organization is not owned, organized, or controlled by the government of a Foreign Country of Concern.
The attestation requires a signed declaration under penalties of perjury, with space provided for the printed name, title, signature, and date of the authorized representative. The form is primarily focused on preventing entities with significant foreign government connections from accessing personal identifying information through government contracts, serving as a protective measure for state and local government procurement processes.
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Text version
FORM 3
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:
PUR 1355 (10/23) Page 1 of 1 Rule 60A-1.020, F.A.C.
File details come from the government source that posted it. Updated .