RFP_10790_Attachment L _Attestation Form.docx
DOCX document 31 KB Posted
- Attached to
- RES 72-Bed-MHOS-SAOS-Nonsecure-Boys
- Solicitation number
- RFP-07375
- Issued by
- Marion County, Orlando City, Florida
About this file
The document is an Attestation Form that must be completed by 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. 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 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.
The related state and local contract opportunity is for a 72-bed nonsecure residential program for males ages 15-18 who need Mental Health Overlay Services or Substance Abuse Treatment Overlay Services. The program is to be located in a Department-owned building in Ocala, Florida or a Respondent-owned/leased building in Florida. The contract term is from 6/10/2024 onwards. Key dates include an Addendum 1 on 1/18/2024 and an Informational Notice #2 on 2/1/2024 adding the Attestation Form requirement.
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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 .