Affidavit Regarding Labor & Services.docx
DOCX document 23 KB Posted
- Attached to
- DISTRICTWIDE TITLE SEARCH AND EXAMINATION SERVICES FLORIDA DEPARTMENT OF TRANSPORTATION – DISTRICT
- Solicitation number
- RFP-12134
- Issued by
- Broward County, Graceville City, Florida
About this file
The document is an Affidavit Regarding Labor and Services from the Florida Department of Transportation (FDOT), requiring nongovernmental entities to provide a signed affidavit attesting that they do not use coercion for labor or services when executing, renewing, or extending a contract with a governmental entity. The affidavit, effective July 1, 2024, is based on Florida Statute 787.06(13) and must be signed by an authorized representative under penalty of perjury, with notarization required. The form includes fields for the nongovernmental entity's name, address, contact information, and a sworn statement declaring the absence of labor coercion.
Accompanying the affidavit is a related state and local contract opportunity for Districtwide Title Search and Examination Services by FDOT District Four, covering multiple Florida counties. The procurement seeks a Florida-licensed attorney or title agent to perform comprehensive title research and reporting services, with a contract value of $1,050,000.00 and an initial approved amount of $210,000.00. The contract will run for five years from June 27, 2025, to June 26, 2030, with potential three-year renewal. Evaluation criteria include technical factors (100 points) and pricing (11 points), with key deadlines including a pre-proposal conference on April 11, 2025, and proposal submissions due April 24, 2025. The solicitation encourages Disadvantaged Business Enterprise (DBE) participation and requires vendors to be registered in the MyFloridaMarketPlace system.
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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 .