Form 3 - Foreign Countries of Concern.pdf

Form 3 - Foreign Countries of Concern Attestation (PUR 1355) is a compliance document required by the Florida Division of Emergency Management for the WebEOC contract opportunity (ITB-DEM-25-26-020). This 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 form requires the signatory to attest 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 attestation is governed by Rule 60A-1.020, F.A.C., and requires the printed name, title, signature, and date of the attesting officer or representative. A second signatory line is also provided for additional verification. This form is a standard Florida procurement requirement designed to ensure that contractors meet specified foreign ownership and control restrictions before being awarded state contracts involving access to sensitive personal information.