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-15845
- Issued by
- Broward County, Fruitville CDP, Florida
About this file
This is an affidavit form issued by the Florida Department of Transportation regarding labor and services compliance, effective July 1, 2024. The affidavit is required for all nongovernmental entities executing, renewing, or extending contracts with governmental entities in Florida. The form must be completed and signed by an authorized representative of the contracting nongovernmental entity and notarized under penalty of perjury. The affidavit attests that the nongovernmental entity does not use coercion for labor or services as defined in Florida Statutes Section 787.06.
The affidavit template requires the nongovernmental entity to provide identifying information including the entity's name, address, phone number, authorized representative's name, title, and email address. The authorized representative must declare under penalty of perjury that the entity complies with Florida labor coercion laws. The affidavit must be notarized either through physical presence or online notarization, with the notary public noting the method of identification verification and commission expiration date. This requirement applies to the District Wide Title Search and Examination Services procurement for Florida Department of Transportation District Four and is mandatory for all bidders, proposers, and respondents to state and local contract opportunities in Florida.
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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 .