375-030-31_Affidavit_Regarding_Labor_and_Services.docx
DOCX document 23 KB Posted
- Attached to
- Lake Management Services State and local contract opportunity
- Solicitation number
- ITB 25-090
- 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, applicable to the City of Fort Myers Lake Management Services procurement (ITB 25-090). The affidavit must be executed by an authorized representative of the selected nongovernmental contractor and submitted upon contract execution, renewal, or extension. The form requires the contractor to attest under penalty of perjury that the nongovernmental entity does not use coercion for labor or services as defined in Florida Statute 787.06, effective July 1, 2024. The affidavit must be notarized and include the contractor's name, address, phone number, authorized representative name and title, email address, and sworn statement. Notarization can be completed through physical presence or online notarization, with the notary public identifying whether the signer was personally known or produced identification.
This document serves as a compliance requirement for the City of Fort Myers' Lake Management Services contract, which encompasses monthly maintenance services at 16 locations including aquatic weed control, buffer management, pond algae control, shoreline weed control, visual inspections, and quarterly maintenance of aeration systems and fountains. The pre-submittal meeting was scheduled for September 16, 2025, with questions due by October 1, 2025, and proposals due October 10, 2025, with City Council approval anticipated for November 3, 2025. The five-year contract includes month-to-month extension options and requires the selected contractor to hold a valid pesticide applicator license with certified applicators, maintain appropriate insurance, comply with E-Verify requirements, and meet the City's 10.54% Disadvantaged Business Enterprise goal using a race-neutral program. Build America, Buy America provisions requiring U.S.-manufactured materials and products also apply to this procurement.
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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 .