375-030-31_Affidavit_Regarding_Labor_and_Services.docx

This is an Affidavit Regarding Labor and Services form issued by the Florida Department of Transportation, applicable to the City of Fort Myers' Sanitary Sewer Evaluation Survey Program procurement for Cure-In-Place Pipe (CIPP) Lining on-call contractors. The affidavit is a mandatory compliance document effective July 1, 2024, required when contracts are executed, renewed, or extended between nongovernmental entities and governmental entities in Florida. The form requires an authorized representative of the contracting nongovernmental entity to attest under penalty of perjury that the entity does not use coercion for labor or services as defined in Florida Statutes 787.06. The document includes sections for the nongovernmental entity's name, address, phone number, and authorized representative information, along with signature and notarization requirements.

The affidavit must be signed by an authorized officer or representative of the nongovernmental entity and notarized before a Notary Public, with the notary verifying the signatory's identity through either physical presence or online notarization. The form includes checkboxes for the notary to indicate the method of verification used and the type of identification produced. This affidavit serves as a statutory requirement for participation in the City of Fort Myers' CIPP contractor procurement (RSQ 25-094), with a contract term of five years and potential for multiple contractor awards. Contractors must submit this completed and notarized affidavit as part of their qualification documentation by the September 11, 2025 submission deadline.