375-030-31_Affidavit_Regarding_Labor_and_Services.docx
DOCX document 23 KB Posted
- Solicitation number
- RSQ 25-093
- Issued by
- Lee County, Fort Lauderdale City, Florida
About this file
This is an Affidavit Regarding Labor and Services form issued by the State of Florida Department of Transportation for Procurement 375-030-31, effective July 1, 2024. The affidavit is required under Florida Statutes 787.06(13) and must be completed and signed by a nongovernmental entity's authorized representative when executing, renewing, or extending a contract with a governmental entity. The form requires the nongovernmental entity to attest under penalty of perjury that it does not use coercion for labor or services. The document includes fields for the nongovernmental entity's name, address, phone number, and authorized representative information, followed by a signature block and notarization section. No specific contract dates, quantities, or project details are contained within this document.
The affidavit serves as a compliance certification requirement with no pricing terms or contract values specified. This document is a mandatory prerequisite for any nongovernmental entity entering into a contractual relationship with the City of Fort Myers or other Florida governmental entities. The notarization requirement can be satisfied through either physical presence or online notarization, and the notary public is not required when digital notarization is utilized. The form is relatively straightforward and serves solely as a certification mechanism to ensure contractors comply with Florida's anti-coercion labor statutes before contract execution or renewal.
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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 .