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), mandated by Florida Statutes 787.06(13), which requires nongovernmental entities to provide an affidavit attesting that they do not use coercion for labor or services when executing, renewing, or extending contracts with governmental entities. The affidavit must be signed by an authorized representative under penalty of perjury, including details such as the nongovernmental entity's name, address, contact information, and a sworn statement confirming compliance with labor coercion regulations.
This affidavit is specifically tied to the FDOT District Four's solicitation for Districtwide Title Search and Examination Services, a contract valued at $1,050,000.00 with an initial $210,000.00 currently approved. The procurement requires proposers to be Florida-licensed attorneys or title agents, with at least 50% company ownership by the professional. The contract will have a five-year initial term from June 27, 2025, to June 26, 2030, with potential three-year renewal options. Proposers must be registered in the MyFloridaMarketPlace system, comply with various certification requirements, and adhere to federal and state regulations including Title VI of the Civil Rights Act and non-discrimination statutes.
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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 .