ITN_10848_Attachment L.docx
DOCX document 31 KB Posted
- Attached to
- CINS/FINS & Statewide Respite Care Services
- Solicitation number
- ITN-09961
- Issued by
- Leon County, Florida
About this file
This document is a Foreign Country of Concern Attestation form (PUR 1355) required for a Governmental Entity contract opportunity. The form must be completed by an entity submitting a bid, proposal, or reply to, or entering into, renewing, or extending, a contract that would grant the entity access to an individual's Personal Identifying Information. The form requires the entity to attest that it is not owned by, organized under the laws of, or 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 information provided on the form includes the printed name, title, and signature of an officer or representative of the entity, attesting to the truthfulness of the statement under penalties of perjury.
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Text version
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 .