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 Regarding Labor and Services form required by the Florida Department of Transportation for the District Wide Title Search and Examination Services procurement (DOT-RFP-27-4001-CO). Effective July 1, 2024, pursuant to Florida Statutes 787.06(13), all nongovernmental entities executing, renewing, or extending contracts with governmental entities must provide a signed affidavit attesting that the entity does not use coercion for labor or services. The form requires completion by an authorized representative of the nongovernmental entity and must be notarized. The affidavit includes fields for the entity's name, address, phone number, authorized representative's name and title, email address, and signature, along with notarization details including the county, date, notary commission expiration, and identification verification method.
The affidavit serves as a compliance requirement for respondents to the FDOT District Four title search and examination services solicitation. All bidders and proposers must submit this signed and notarized document as part of their proposal package. The form emphasizes that the authorized representative attests under penalty of perjury that the nongovernmental entity does not engage in labor coercion as defined in Florida law. This requirement applies to the contract term extending through August 13, 2031, with potential renewal for up to three additional years, and encompasses the maximum budgetary limitation of $1,050,000 established for the procurement.
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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 .