375-030-31_Affidavit_Regarding_Labor_and_Services.docx
DOCX document 23 KB Posted
- Attached to
- NRCS Emergency Watershed Protection Grant
- Solicitation number
- ITB 25-092
- Issued by
- Lee County, Fort Lauderdale City, Florida
About this file
This is an Affidavit Regarding Labor and Services form required by the State of Florida Department of Transportation for the NRCS Emergency Watershed Protection Grant procurement (ITB 25-092) issued by the City of Fort Myers. The affidavit is mandated effective July 1, 2024, pursuant to Florida Statutes 787.06(13) and must be executed when a contract is entered into, renewed, or extended between a nongovernmental entity and a governmental entity. The form requires the nongovernmental entity's authorized representative to attest under penalty of perjury that the entity does not use coercion for labor or services as defined by Florida law. The affidavit must be signed by an authorized officer or representative of the contractor and notarized before a notary public, with options for either physical presence or online notarization.
The affidavit template requires completion of standard identification information including the nongovernmental entity's name, address, phone number, authorized representative's name, title, and email address. The notarization section allows for either personal knowledge or produced identification verification, with the notary public's commission expiration date and signature required. This affidavit is a prerequisite compliance document for the construction management contract related to stream debris and sediment removal across multiple waterways in Lee County, Florida, and must be submitted as part of the bidder's proposal package to demonstrate compliance with Florida's labor and human trafficking prevention requirements.
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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 .