12-M. Affidavit of Compliance.pdf
PDF 152 KB Posted
- Attached to
- 26Q-093 General Planning Consultants for the Ocala-Marion County Transportation Planning Organization (TPO)
- Solicitation number
- 26-093
- Issued by
- Marion County, Florida
About this file
This is an Affidavit of Compliance form from the State of Florida Department of Transportation required under Florida Statutes 787.06(14). The affidavit must be executed by nongovernmental entities entering into, renewing, or extending contracts with governmental entities, effective July 1, 2024. The form requires completion of the nongovernmental entity's name, address, phone number, and authorized representative information, along with a sworn statement under penalty of perjury that the entity does not use coercion for labor or services as defined in Florida law.
The affidavit must be notarized by a notary public, with certification of the method of notarization (physical presence or online), the date, and identification of the signatory. This form is a mandatory compliance document applicable to the referenced contract opportunity for General Planning Consultants for the Ocala-Marion County Transportation Planning Organization (TPO), which involves professional support for transportation planning functions on a task order basis. No specific pricing terms, contract duration, or additional financial requirements are detailed in this compliance document, as it serves solely to establish labor practice compliance as a condition of contract execution.
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Text version
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
AFFIDAVIT REGARDING LABOR AND SERVICES
375-030-31
PROCUREMENT
11/25
Effective July 1, 2024, pursuant to §787.06(14), Florida Statutes, when a contract is executed, renewed, or extended between a nongovernmental entity and a governmental entity, the nongovernmental entity must provide the governmental entity with an affidavit signed by an officer or a representative of the nongovernmental entity under penalty of perjury attesting that the nongovernmental entity does not use coercion for labor or services.
Nongovernmental Entity's Name:
Address:
Phone Number:
Authorized Representative’s Name:
Authorized Representative’s Title:
Email Address:
AFFIDAVIT
I, insert nongovernmental entity's authorized representative name, as authorized representative attest that insert nongovernmental entity's namedoes not use coercion for labor or services as defined in §787.06, Florida Statutes.
Under penalty of perjury, I declare that I have read the foregoing Affidavit and that the facts stated in it are true.
(Signature of authorized representative) Date
STATE
COUNTY OF
Sworn to (or affirmed) and subscribed before me, by means of physical presence or online notarization, this day of , (year), by
Notary Public
Commission Expires
Personally Known OR Produced Identification Type of Identification Produced
File details come from the government source that posted it. Updated .