Form PUR 1355.pdf
PDF 38 KB Posted
- Solicitation number
- ITN-10750
- Issued by
- Hillsborough County, Florida
About this file
This is Form PUR 1355, a Foreign Country of Concern Attestation form required by the State of Florida under Rule 60A-1.020, F.A.C. The form must be completed by any 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 that would grant access to personal identifying information.
The form requires the entity to attest that it is not owned by the government of a Foreign Country of Concern, is not organized under such laws, does not have its principal place of business in such a country, and that no Foreign Country of Concern has a controlling interest in the entity. The form requires the representative's printed name, title, signature, and date under penalty of perjury.
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Other files
| File | Type | Posted |
|---|---|---|
| DOT-ITN-25-7007-EG - ITN PACKAGE.pdf | ||
| TQ&A - 11-5-2024 - REVISED.pdf | ||
| TECHNICAL QUESTIONS AND ANSWERS.pdf | ||
| ADDENDUM #1.pdf | ||
| ADDENDUM #4.pdf | ||
| Form PUR 1355.pdf | ||
| ADDENDUM #2.pdf | ||
| TECHNICAL QUESTIONS AND ANSWERS - 11-5-2024.pdf | ||
| ADDENDUM #3.pdf |
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Text version
PUR 1355 (10/23) Page 1 of 1 Rule 60A-1.020, F.A.C.
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:
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