375-030-31_Affidavit_Regarding_Labor_and_Services.docx
DOCX document 23 KB Posted
- Attached to
- South Street Sidewalk Construction from US 41/Cleveland Avenue to SR 739/Fowler Street (FDOT 438101-2-58-01)
- Solicitation number
- 25-012-ITB
- Issued by
- Lee County, Fort Lauderdale City, Florida
About this file
This document is an Affidavit Regarding Labor and Services issued by the Florida Department of Transportation (FDOT), effective July 1, 2024. The affidavit is a mandatory requirement under Florida Statute 787.06(13), which mandates that any nongovernmental entity executing, renewing, or extending a contract with a governmental entity must provide a signed affidavit. The document requires the nongovernmental entity's authorized representative to attest, under penalty of perjury, that the organization does not use coercion for labor or services as defined in the referenced statute.
The affidavit is a standardized form that must be completed with the nongovernmental entity's details, including name, address, contact information, and authorized representative's information. The document includes spaces for a notarized signature, with options for physical or online notarization, and requires the representative to declare the truthfulness of the statements made. While the document does not specify specific contract details or monetary values, it serves as a critical compliance mechanism to ensure ethical labor practices for entities engaging in contracts with governmental bodies in Florida.
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Text version
STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION
AFFIDAVIT REGARDING LABOR AND SERVICES
375-030-31
PROCUREMENT
07/24
Effective July 1, 2024, pursuant to §787.06(13), 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 OF FLORIDA
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, not required when digital
Commission Expires
Personally Known |_| OR Produced Identification |_| Type of Identification Produced
File details come from the government source that posted it. Updated .