Affidavit Regarding Labor and Services.docx

DOCX document 28 KB Posted

Attached to
District Seven Storm Drain Video Inspection Services
Solicitation number
ITB-16600
Issued by
Hillsborough County, Florida

About this file

This is an affidavit form issued by the Florida Department of Transportation that applies to all state and local contracts executed, renewed, or extended on or after July 1, 2024. The affidavit requirement mandates that nongovernmental entities provide signed attestations under penalty of perjury confirming they do not use coercion for labor or services as defined in Florida Statutes section 787.06(14). The affidavit must be completed by an authorized representative of the contracting entity and notarized before a notary public. The form requires standard information including the nongovernmental entity's name, address, phone number, authorized representative's name and title, email address, and notarization details such as date, county of notarization, and method of notarization (physical presence or online).

The affidavit applies specifically to the Florida Department of Transportation's District Seven Storm Drain Video Inspection Services contract opportunity. All bidders for this procurement must be registered in Florida's MyFloridaMarketplace system, and out-of-state corporations, limited liability companies, and limited partnerships must be authorized to do business in Florida. Bidders must possess proper licensure if required by the Florida Department of Business and Professional Regulation. Current District Seven Storm Drain Video Inspection Services contract vendors are ineligible to submit bids on this solicitation. Additionally, all respondents are prohibited from contacting executive or legislative branch employees regarding the solicitation during the 72-hour period following the notice of intended award, excluding weekends and state holidays, except in writing to the procurement officer.

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ITB Complete Package.pdf PDF
PUR1355 Attestation Form.docx DOCX document

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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 .