7-Affidavit Regarding Labor & Services.pdf

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Attached to
DISTRICTWIDE IMPLEMENTATION AND MAINTENANCE OF NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDE
Solicitation number
RFP-12807
Issued by
Broward County, Graceville City, Florida

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This document is an Affidavit Regarding Labor and Services form issued by the State of Florida Department of Transportation (FDOT), effective July 1, 2024. The form is designed to comply with §787.06(13), Florida Statutes, requiring nongovernmental entities to provide a signed affidavit to governmental entities when executing, renewing, or extending a contract. The affidavit serves to attest that the nongovernmental entity does not use coercion for labor or services, and must be signed by an authorized representative under penalty of perjury.

The form includes blank fields for the nongovernmental entity's name, address, contact information, and authorized representative details. It provides a template for the affidavit statement and includes a section for notarization, with options for physical presence or online notarization. The document is part of FDOT's procurement process and aims to ensure ethical labor practices by contractors working with governmental entities in Florida, with the affidavit serving as a legal declaration of compliance with state statutes regarding labor and services.

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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 .