375-030-31_Affidavit_Regarding_Labor_and_Services.docx
DOCX document 23 KB Posted
- Solicitation number
- RSQ 25-093
- Issued by
- Lee County, Fort Lauderdale City, Florida
About this file
The document is an Affidavit Regarding Labor and Services issued by the Florida Department of Transportation, effective July 1, 2024. The affidavit is a mandatory requirement for nongovernmental entities executing, renewing, or extending contracts with governmental entities, specifically addressing labor and services coercion compliance under Florida Statutes 787.06(13). The form requires an authorized representative of the nongovernmental entity to sign a sworn statement attesting that the organization does not use coercion for labor or services.
The related state and local contract opportunity involves a Sanitary Sewer Evaluation Survey Program for on-call underground utilities contractors in the City of Fort Myers, Florida. The City's Public Utilities Department is seeking qualified vendors to provide comprehensive utility and stormwater management system contracting services. Contractors will be responsible for understanding and complying with local, state, and federal building codes and regulations, with the procurement process being conducted through a Request for Statement of Qualification (RSQ) to identify and select qualified contractors for potential project work.
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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 .