Affidavit Regarding Labor & Services.docx
DOCX document 23 KB Posted
- Attached to
- DISTRICT WIDE TITLE SEARCH AND EXAMINATION SERVICES FOR FLORIDA DEPARTMENT OF TRANSPORTATION – DISTR
- Solicitation number
- RFP-10374
- Issued by
- Broward County, Graceville City, Florida
About this file
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), 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 authorized representative attesting that the nongovernmental entity does not use coercion for labor or services. The affidavit requires the nongovernmental entity's name, address, phone number, authorized representative's name, title, and email address. The authorized representative must sign the affidavit under penalty of perjury, declaring that the nongovernmental entity does not use coercion for labor or services as defined in 787.06, Florida Statutes.
The affidavit must be notarized, either by physical presence or online notarization. The notary public's information, including their commission expiration date and whether the signer is personally known or has provided identification, must be included on the affidavit.
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Text version
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 .