FORM 8 - PUR1355 Foreign Country of Concern Attestation.docx
DOCX document 33 KB Posted
- Solicitation number
- ITN-12216
- Issued by
- Jackson County, Gulf Breeze City, Florida
About this file
This document is a Foreign Country of Concern Attestation form (PUR 1355) used by governmental entities in Florida for bid, proposal, or contract processes. The form requires an officer or representative of an entity to certify that their organization is not owned, organized, or controlled by the government of a foreign country of concern when submitting a bid or entering into a contract that would provide access to personal identifying information.
The attestation specifically requires the entity to declare under penalties of perjury that they are not owned by a foreign government of concern, not organized under such a country's laws, do not have their principal place of business in a foreign country of concern, and that no foreign government has a controlling interest in the entity. The form provides spaces for the printed name, title, signature, and date of the authorized representative making this declaration, and is associated with Rule 60A-1.020 of the Florida Administrative Code.
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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 .