375-030-31_Affidavit_Regarding_Labor_and_Services.docx
DOCX document 23 KB Posted
- Solicitation number
- ITB 25-076
- Issued by
- Lee County, Fort Lauderdale City, Florida
About this file
The document is an Affidavit Regarding Labor and Services from the Florida Department of Transportation, effective July 1, 2024, which mandates that nongovernmental entities executing contracts with governmental entities must provide a signed affidavit affirming they do not use coercion for labor or services. The related state and local contract opportunity is a service line field investigation and meter box maintenance project for the City of Fort Myers, Florida, involving the inspection and cleaning of 371 service connections and meter boxes throughout the city.
The affidavit requires the nongovernmental entity's authorized representative to attest, under penalty of perjury, that they do not use coercion for labor or services as defined in Florida Statutes 787.06(13). The document provides a template for the affidavit, including fields for the entity's name, address, contact information, and a space for the authorized representative's signature and notarization. While the affidavit is a mandatory compliance document, it does not provide specific details about pricing, funding, or contract terms for the City of Fort Myers' service line and meter box maintenance project.
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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 .