RFP 11108_Attachment L_final.pdf

This document is a Foreign Country of Concern Attestation form (PUR 1355) issued by the State of Florida pursuant to Rule 60A-1.020, F.A.C., required for entities submitting bids or proposals to or entering into contracts with a Governmental Entity that would grant access to an individual's Personal Identifying Information. The form pertains to a Request for Proposal (RFP 11108) for a forty-two-bed high-risk residential program for males aged thirteen to eighteen requiring Mental Health Overlay Services (MHOS) and/or Substance Abuse Treatment Overlay Services (SAOS). The program is to be located either in a Department-owned building at 286 Gene Hurley Road, DeFuniak Springs, Florida 32433, in Circuit 1 of the Department's Northwest region, or in a Respondent-owned or leased building within the State of Florida. The program shall include innovations in delinquency programming and treatment services, health and nursing services, electronic health record integration, academic services, career and technical education services, and mental health and substance abuse treatment overlay services, with flexibility in bed allocation based on departmental needs.

By executing this attestation, the entity's authorized officer or representative certifies 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. This attestation is a mandatory compliance document that must be completed and signed by an officer or representative of any bidding or contracting entity.