375-030-31_Affidavit_Regarding_Labor_and_Services.docx
DOCX document 23 KB Posted
- Attached to
- Architectural Services Continuing Contract State and local contract opportunity
- Solicitation number
- 25-069-RSQ
- Issued by
- Lee County, Fruitville CDP, Florida
About this file
This is an Affidavit Regarding Labor and Services form issued by the State of Florida Department of Transportation, applicable to all contracts executed, renewed, or extended between nongovernmental entities and governmental entities effective July 1, 2024, pursuant to Florida Statutes 787.06(13). The form requires authorized representatives of nongovernmental entities to attest under penalty of perjury that their organization does not use coercion for labor or services as defined in state law. The affidavit must be completed with the nongovernmental entity's name, address, phone number, authorized representative's name and title, email address, and the representative's signature. The document requires notarization by a notary public, either through physical presence or online notarization, with the notary verifying personal knowledge of the representative or identification produced.
This affidavit applies to the City of Fort Myers' Request for Statement of Qualifications (RSQ 25-069) for architectural services under a continuing contract, establishing a three-year initial term with two potential one-year renewal options. Any architectural firm selected for this procurement must provide the completed affidavit prior to contract execution to comply with Florida law. The form serves as a prerequisite compliance document and does not contain pricing terms, set-asides, or funding information, functioning instead as a mandatory labor and services certification required across all state and local government contracts in Florida.
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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 .