375-030-31_Affidavit_Regarding_Labor_and_Services.docx
DOCX document 23 KB Posted
- Attached to
- Emergency Bypass Pumps Rental & Delivery (Disaster Contract) State and local contract opportunity
- Solicitation number
- ITB 25-075
- Issued by
- Lee County, Fruitville CDP, Florida
About this file
The document is an Affidavit Regarding Labor and Services form from the Florida Department of Transportation (FDOT), effective July 1, 2024, which requires nongovernmental entities to provide a signed affidavit attesting that they do not use coercion for labor or services when executing, renewing, or extending contracts with governmental entities. The affidavit must be signed by an authorized representative under penalty of perjury, following the statutory requirements of 787.06(13), Florida Statutes.
The related state and local contract opportunity involves two distinct procurement efforts: Citrus County's ITB 25-075 for well pump and motor repair services, and the City of Fort Myers' request for emergency bypass pump rentals. Citrus County seeks contractors to maintain and repair approximately 40 wells across 14 water treatment plants, with the intent to award contracts to two responsive and responsible bidders. The City of Fort Myers is specifically requesting 4-inch bypass pumps with specific technical requirements, including cam lock connections, 40 feet of suction and discharge hoses, and a preference for silent units. Both procurements emphasize compliance with Disadvantaged Business Enterprise (DBE) goals, federal regulations, and local participation requirements, with Citrus County having approximately $85,000 budgeted for the well pump and motor repair contract.
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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 .