RFP_10956_Attachment_L.pdf
PDF 61 KB Posted
- Attached to
- RES-Moderate-28-Beds-Female-SAOS-MHOS-NE-Region
- Solicitation number
- RFP-12669
- Issued by
- Alachua County, Glencoe CDP, Florida
About this file
This document is a Foreign Country of Concern Attestation form (PUR 1355) issued under Rule 60A-1.020, F.A.C., designed for entities submitting bids, proposals, or entering contracts with governmental entities that would provide access to personal identifying information. The form requires an officer or representative of the entity to declare that their organization is not owned by, organized under the laws of, or principally located in a Foreign Country of Concern, and that no such government has a controlling interest in the entity.
The attestation must be signed under penalties of perjury, with the signatory affirming the truthfulness of the statement. The form provides space for the printed name, title, signature, and date of the authorized representative completing the document. It is a standardized form intended to ensure transparency and security in governmental contracting by screening out potential entities with significant foreign government connections.
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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:
https://www.flrules.org/gateway/RuleNo.asp?title=GENERAL%20REGULATIONS&ID=60A-1.020
File details come from the government source that posted it. Updated .