Affidavit Regarding Labor & Services.pdf

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Attached to
DATA NETWORK STRUCTURED CABLING SYSTEM FOR FLORIDA DEPARTMENT OF TRANSPORTATION - DISTRICT 4 & DIST
Solicitation number
ITB-14978
Issued by
Broward County, Graceville City, Florida

About this file

This is an Affidavit Regarding Labor and Services form required by the Florida Department of Transportation for a Data Network Structured Cabling System procurement for District 4 and District 6 Materials & Research Office. Effective July 1, 2024, pursuant to Florida Statutes section 787.06(13), this affidavit must be signed by an authorized representative of any nongovernmental entity executing, renewing, or extending a contract with the state. The form requires completion of the nongovernmental entity's name, address, phone number, and authorized representative information, followed by a notarized attestation that the entity does not use coercion for labor or services as defined in Florida law.

The affidavit must be executed under penalty of perjury and sworn before a notary public, either by physical presence or through online notarization. The authorized representative signs the document attesting to compliance with Florida labor statutes, and the notary verifies the signatory's identity through personal knowledge or identification. All prospective bidders, proposers, and respondents for this solicitation must be registered in the State of Florida's MyFloridaMarketplace system, and out-of-state entities providing services must be authorized to do business in Florida and hold appropriate licensure from the Florida Department of Business and Professional Regulation if required by their industry.

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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 .