375-030-31_Affidavit_Regarding_Labor_and_Services.docx
DOCX document 23 KB Posted
- Attached to
- Surveying & Mapping Services Continuing Contract State and local contract opportunity
- Solicitation number
- 25-067-RSQ
- Issued by
- Lee County, Fruitville CDP, Florida
About this file
The document is an Affidavit Regarding Labor and Services from the Florida Department of Transportation, effective July 1, 2024, related to a Surveying & Mapping Services Continuing Contract. The City is seeking professional qualifications from Surveying and Mapping Consultants to provide services on an as-needed basis under a continuing contract in accordance with the State of Florida Consultants Competitive Negotiation Act (CCNA).
The affidavit requires nongovernmental entities executing, renewing, or extending contracts with governmental entities to provide a signed document attesting that they do not use coercion for labor or services, as defined in Florida Statutes 787.06. The affidavit must be signed by an authorized representative under penalty of perjury, including details such as the entity's name, address, contact information, and the representative's credentials. The document includes a notarization section to formally validate the attestation.
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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 .