24-84131503-ITB Business Automobile Attachment M PUR 2024.pdf
PDF 119 KB Posted
- Attached to
- Business Automobile Insurance
- Solicitation number
- ITB-10265
- Issued by
- Duval County, Lee County, Leon County, Fort Lauderdale City, Florida
About this file
This document is an attachment to a solicitation for business automobile insurance issued by the State of Florida. The solicitation requires the contractor to market and secure an insurance policy that provides coverage at least as good as the expiring policy, as detailed in Attachment J, and meets the minimum coverage requirements specified in Section 5. The insurance policy must have an effective date of October 20, 2024, or another date that prevents a lapse in coverage.
The document also includes certifications that must be completed by the entity submitting a response. Part A certifies that the entity does not use coercion for labor or services, while Part B certifies that the commodities offered have not been produced by forced labor.
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Text version
Solicitation No. 24-84131503-ITB Business Automobile Insurance
Attachment M
PUR 2024
Part A: Use of Coercion for Labor and Services
Pursuant to section 787.06(13), Florida Statutes, this portion of the form must be completed by an officer or representative of the nongovernmental entity executing, renewing, or extending a contract with a governmental entity.
Name of entity does not use coercion for labor or services as defined in section 787.06, Florida Statutes.
Under penalties of perjury, I declare that I have read the foregoing statement and that the facts stated in it are true.
Entity Name:
Representative/Officer’s Printed Name:
Representative/Officer’s Title:
Signature: Date:
Part B: Provision of Commodities Produced by Forced Labor
Pursuant to section 287.1346(4)(b), Florida Statutes, this portion of the form must be completed by a member of the company’s senior management, as defined in section 287.1346, F.S., when the company submits a response to a solicitation for the provision of commodities and before the company enters into or renews a contract for the provision of commodities.
I certify that to the best of my knowledge, the commodities Name of entity is offering to the Department have not been produced, in whole or in part, by forced labor.
Entity Name:
Senior Management’s Printed Name:
Senior Management member’s Title:
Signature: Date:
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