375-030-31_Affidavit_Regarding_Labor_and_Services.docx
DOCX document 23 KB Posted
- Attached to
- Meter Changeout Supplies State and local contract opportunity
- Solicitation number
- 25-046-ITB
- Issued by
- Lee County, Fort Lauderdale City, Florida
About this file
The document is a Florida Department of Transportation (FDOT) Affidavit Regarding Labor and Services form, effective July 1, 2024, designed to ensure that nongovernmental entities contracting with governmental entities do not use coercion for labor or services. The affidavit is part of a broader procurement process related to a City of Fort Myers meter changeout supplies solicitation (number 25-046-ITB) scheduled for advertisement on April 17, 2025, with vendor questions due by May 1, 2025, and submissions required by May 19, 2025 at 2:00 pm. The project aims to procure supplies for an estimated 12,000 meter replacements, with a total estimated supply cost of $52,593.73 and a per-changeout supply cost of $4.38.
The procurement includes multiple compliance and preference requirements, including a Minority Business Enterprise (MBE) goal of 15% and location-based scoring (5 points for a Fort Myers city office, 3 points for a Lee County office). Contractors must comply with diverse regulations, including Build America, Buy America (BABA) provisions mandating U.S. production of materials, Disadvantaged Business Enterprise (DBE) requirements with a 10.54% participation goal, and various anti-lobbying and human trafficking certifications. The contract is proposed for City Council approval on June 2, 2025, with an initial three-year term and potential price escalations limited to the Consumer Price Index (CPI-U) or a maximum of 3% annually. Bidders must be registered in Florida, possess a valid business license, and use the E-Verify system for employee work authorization.
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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 .