PUR1355.docx
DOCX document 31 KB Posted
- Attached to
- DISTRICT WIDE TITLE SEARCH AND EXAMINATION SERVICES FOR FLORIDA DEPARTMENT OF TRANSPORTATION - DISTR
- Solicitation number
- RFP-15845
- Issued by
- Broward County, Fruitville CDP, Florida
About this file
This is a Foreign Country of Concern Attestation form (PUR 1355) required by the Florida Department of Transportation for the District Wide Title Search and Examination Services procurement in District Four. The attestation must be completed by an officer or representative of any entity submitting a bid, proposal, or reply to this contract opportunity, or for entities renewing or extending an existing contract that would grant access to an individual's Personal Identifying Information. The form requires the executing officer to declare under penalties of perjury that the entity is not owned by the government of a Foreign Country of Concern, is not organized under the laws of a Foreign Country of Concern, does not 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.
All prospective bidders and respondents must register in Florida's MyFloridaMarketplace system prior to submission. Out-of-state corporations, limited liability companies, and limited partnerships must be authorized to do business in Florida through the Florida Department of State. Additionally, bidders must hold appropriate professional licenses from the Florida Department of Business and Professional Regulation if required for the services being provided. Respondents are prohibited from contacting any employee or officer of the executive or legislative branch regarding the solicitation between its release and 72 hours following the agency's posting of the notice of intended award, excluding weekends and state holidays, except in writing to the procurement officer as specified in the solicitation documents.
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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 .