Form 5 - PUR1355 Foreign Countries.pdf
PDF 116 KB Posted
- Solicitation number
- RFP-11961
- Issued by
- Leon County, Florida
About this file
The document is Form 5, a Foreign Country of Concern Attestation form (PUR 1355) required by a Governmental Entity for bid, proposal, or contract submissions that would provide access to an individual's Personal Identifying Information. The form is designed to verify that the bidding entity is not owned, organized, or controlled by the government of a Foreign Country of Concern, as defined in Rule 60A-1.020, F.A.C.
The attestation form requires an officer or representative of the bidding entity to declare under penalties of perjury that their organization meets the specified criteria regarding foreign country ownership and control. The form includes blank fields for the printed name, title, signature, and date of the attesting individual, serving as a legal declaration of the entity's compliance with governmental procurement regulations related to foreign ownership and potential information security risks.
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Text version
Form 5
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.
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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