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
This is an affidavit form from the Florida Department of Transportation (FDOT) regarding labor and services compliance for the City of Fort Myers Surveying & Mapping Services Continuing Contract. The affidavit requires nongovernmental entities executing, renewing, or extending contracts with governmental entities to certify under penalty of perjury that they do not use coercion for labor or services, as defined in Florida Statute 787.06. The form became effective July 1, 2024, and applies to this three-year surveying and mapping services continuing contract with two potential one-year renewal options. The affidavit must be signed by an authorized representative of the contractor and notarized, with the notary public not required if digital notarization is used. Submission of this completed affidavit is mandatory upon contract execution, renewal, or extension.
The affidavit contains fields for the nongovernmental entity's name, address, phone number, authorized representative's name, title, and email address. The document serves as compliance verification for labor standards and must be executed before a notary public through either physical presence or online notarization. No pricing, set-asides, or other financial terms are specified in this compliance document; rather, it functions solely as a certification requirement that bidders must fulfill as part of the contracting process for surveying and mapping services with the City of Fort Myers.
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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 .