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 Invitation to Bid (ITB) for Business Automobile Insurance on behalf of the State of Florida and the current Named Insureds. The Contractor shall market and secure an Insurance Policy that meets or exceeds the coverage requirements outlined in ITB Attachment J, Expiring Policy. The insurance policy shall have an effective date of October 20, 2024, or another date that prevents a lapse in coverage. The jurisdictions included are Duval County, Lee County, Leon County, and Fort Lauderdale City.
The Contractor must certify that the commodities being offered have not been produced, in whole or in part, by forced labor, and that the Contractor does not use coercion for labor or services as defined in Florida Statutes. Pricing for the insurance policy shall be provided in the Bid and conform to Florida Statutes. No further details are provided regarding pricing terms, set asides, incumbents, funding requirements, or sources.
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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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