Affidavit Regarding Labor and Services.docx

DOCX document 28 KB Posted

Attached to
District Seven Storm Drain Video Inspection Services
Solicitation number
ITB-15995
Issued by
Hillsborough County, Florida

About this file

This is an Affidavit Regarding Labor and Services form issued by the Florida Department of Transportation (FDOT) for use in state and local contract procurements. The affidavit is required effective July 1, 2024, pursuant to section 787.06(14) of the Florida Statutes, and must be executed when a contract is entered into, renewed, or extended between a nongovernmental entity and a governmental entity. The form requires the nongovernmental entity's authorized representative to attest under penalty of perjury that the entity does not use coercion for labor or services as defined in Florida law. The affidavit must be notarized and signed by the authorized representative, with notary acknowledgment including verification of personal identification or physical presence.

The affidavit serves as a compliance document within the context of the District Seven Storm Drain Video Inspection Services procurement solicitation. Bidders responding to this FDOT solicitation must be registered in the State of Florida's MyFloridaMarketplace system, and out-of-state entities must be authorized to do business in Florida. All bidders providing services must maintain proper licensure as required by the Florida Department of Business and Professional Regulation. This affidavit requirement ensures that all vendors meet statutory anti-coercion standards and may be submitted as part of the bid documentation or contract execution process for this competitive sealed bid solicitation.

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Text version

STATE OF FLORIDA DEPARTMENT OF TRANSPORTATION

AFFIDAVIT REGARDING LABOR AND SERVICES

375-030-31

PROCUREMENT

11/25

Effective July 1, 2024, pursuant to §787.06(14), 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

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

Commission Expires

Personally Known |_| OR Produced Identification |_| Type of Identification Produced

File details come from the government source that posted it. Updated .