ITN 10908_Attachment L.pdf

The document is a Foreign Country of Concern Attestation form (PUR 1355) required by a governmental entity for contract submissions. 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 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 the government of a Foreign Country of Concern, not organized under the laws of or having 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 must be signed under penalties of perjury, with the signatory declaring that they have read the statement and that the facts stated are true. The form provides space for the printed name, title, signature, and date of the authorized representative. It is associated with Rule 60A-1.020 of the Florida Administrative Code (F.A.C.) and is designed to ensure transparency and security in governmental contracting by preventing potential conflicts of interest or security risks from entities with significant foreign government connections.