7-Affidavit Regarding Labor & Services.docx

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Attached to
DISTRICTWIDE DATA NETWORK STRUCTURED CABLING SYSTEM FOR FLORIDA DEPARTMENT OF TRANSPORTATION DISTRIC
Solicitation number
ITB-10100
Issued by
Broward County, Fruitville CDP, Florida

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This document is an Affidavit Regarding Labor and Services from the State of Florida Department of Transportation. Effective July 1, 2024, pursuant to 787.06(13) of the 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.

The affidavit requires the nongovernmental entity to provide its name, address, phone number, authorized representative's name, title, and email address. The authorized representative must attest under penalty of perjury that the nongovernmental entity does not use coercion for labor or services as defined in 787.06 of the Florida Statutes. The affidavit must be signed by the authorized representative and notarized.

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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 .