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
This document is an Affidavit Regarding Labor and Services from the Florida Department of Transportation (FDOT), effective July 1, 2024, which mandates that nongovernmental entities executing, renewing, or extending contracts with governmental entities must provide an official affidavit. The affidavit requires the nongovernmental entity's authorized representative to attest, under penalty of perjury, that the organization does not use coercion for labor or services as defined in Florida Statute 787.06.
The affidavit is a standardized form that must be completed with the nongovernmental entity's details, including name, address, phone number, authorized representative's name and title, and email address. The document includes spaces for the authorized representative's signature, date, and notarization, with options for physical presence or online notarization. The primary purpose of this document is to ensure compliance with Florida state law by requiring entities doing business with government agencies to formally declare they do not engage in coercive labor practices.
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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 .