375-030-31_Affidavit_Regarding_Labor_and_Services.docx
DOCX document 23 KB Posted
- Solicitation number
- RSQ 25-095
- 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 (FDOT) for procurement 375-030-31, effective July 1, 2024. The form applies to the City of Fort Myers' Sanitary Sewer Evaluation Survey Program seeking multiple Manhole Lining Contractors licensed in Florida to provide comprehensive on-call urgent repair services. The selected contractors will be responsible for complete manhole lining services across various locations, including supervision and administration, manhole cleaning, sandblasting, repairs, and coating/lining installation. The solicitation was released on August 11, 2025, with a questions deadline of August 28, 2025, and bid submissions due by September 11, 2025. A virtual pre-submittal meeting is scheduled with a potential selection committee meeting on October 8, 2025, and City Council approval set for October 20, 2025. The contract term is five years.
Pursuant to Florida Statute 787.06(13), this affidavit is a mandatory requirement for all nongovernmental entities executing, renewing, or extending contracts with governmental entities. The authorized representative of the bidding entity must attest under penalty of perjury that the nongovernmental entity does not use coercion for labor or services. The affidavit must be signed by an authorized officer or representative and notarized before a notary public. Evaluation criteria include project approach (45 points), firm experience and personnel qualifications (55 points), with additional points for Minority Business Enterprise (MBE) policy compliance (13 points) and local vendor preference (5 points). The procurement emphasizes opportunities for Disadvantaged Business Enterprises (DBEs) and MBEs, with FDOT maintaining a 10.54% overall DBE goal. Contractors must comply with Build America, Buy America requirements mandating the use of U.S.-produced materials and must submit a Bidders Opportunity List within three business days of bid submission and maintain an approved DBE Affirmative Action Plan with the FDOT Equal Opportunity Office.
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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 .