24-84131514-ITB Government Crime Attachment L PUR 2024.pdf
PDF 119 KB Posted
- Solicitation number
- ITB-10823
- Issued by
- Leon County, Florida
About this file
This document is Attachment L (PUR 2024) for Florida Department of Management Services' Government Crime Insurance solicitation No. 24-84131514-ITB. The attachment 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 Florida Statutes section 787.06(13), while Part B requires a senior management member to certify that commodities offered to the Department have not been produced using forced labor, as required by Florida Statutes section 287.1346(4)(b).
The document includes signature blocks for both certifications, requiring entity names, representative names and titles, signatures, and dates. The form displays the Department of Management Services logo and is structured as a formal legal document requiring declarations under penalty of perjury. This is a standard compliance document that must be completed as part of the bid submission process for the Government Crime Insurance contract opportunity.
View the file
Other files
Show all 16
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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:
File details come from the government source that posted it. Updated .