24-84131514-ITB Government Crime Attachment L PUR 2024.pdf
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- Solicitation number
- ITB-10823
- Issued by
- Leon County, Florida
About this file
This is Attachment L (PUR 2024) of ITB No. 24-84131514-ITB for Government Crime Insurance from the Florida Department of Management Services. The document contains two certification forms that must be completed by vendors: Part A requires an officer or representative of a nongovernmental entity to certify that their organization does not use coercion for labor or services as defined in section 787.06 of Florida Statutes, while Part B requires a senior management member to certify that commodities offered to the Department have not been produced using forced labor.
The document includes signature blocks requiring entity name, representative/officer information, and dates for both certifications. These forms appear to be mandatory compliance documents that must be completed as part of the bid submission process for the Government Crime Insurance contract opportunity. The document displays the Department of Management Services logo and includes references to specific Florida Statutes (787.06(13) and 287.1346(4)(b)) governing labor practices and commodity procurement.
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Text version
Solicitation No. 24-84131514-ITB Government Crime Insurance
Attachment L
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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