RFP10858_L_ ForeignCountry_Attestation.pdf

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Attached to
Detention screening and intake services at the Broward Circuit 17
Solicitation number
RFP-10327
Issued by
Broward County, Graceville City, Florida

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This is a Foreign Country of Concern Attestation form (PUR 1355) required by the State of Florida under Rule 60A-1.020, F.A.C. The form must be completed by officers or representatives of entities submitting bids, proposals, or replies to governmental contracts that would grant access to personal identifying information.

The form requires the signing entity to attest that they are not owned by, organized under the laws of, or principally located in a Foreign Country of Concern. Additionally, they must certify that no government of a Foreign Country of Concern has a controlling interest in their entity. The attestation must be signed under penalty of perjury with the representative's printed name, title, signature, and date.

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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 .