375-030-31_Affidavit_Regarding_Labor_and_Services.docx
DOCX document 23 KB Posted
- Attached to
- Sanitary Sewer Evaluation Survey Program On-Call Contractors - Cure-In-Place Pipe (CIPP) Lining State and local contract opportunity
- Solicitation number
- RSQ 25-094
- 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 Statutes 787.06(13), which mandates that any nongovernmental entity executing, renewing, or extending a contract with a governmental entity must provide a signed affidavit attesting that they do not use coercion for labor or services. The form requires the nongovernmental entity to complete details such as name, address, contact information, and have an authorized representative sign the document under penalty of perjury.
The related state and local contract opportunity is for a Sanitary Sewer Evaluation Survey Program seeking multiple Cured-in-Place Pipe (CIPP) Contractors licensed in Florida. The contractors will provide comprehensive pipe lining services and on-call urgent repair services for various projects. Specific services include work supervision/administration, sanitary sewer cleaning, CCTV inspection of sanitary sewers, and CIPP installation. The scope indicates the City will request services as needed, with contractors responsible for pipe lining services across different locations.
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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 .