Affidavit Regarding Labor & Services.pdf

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Attached to
CLOUD BASED ARTERIAL MANAGEMENT (CBAM) REGIONAL PLATFORM FOR TREASURE COAST FOR FLORIDA DEPARTMENT
Solicitation number
ITB-12314
Issued by
Broward County, Fruitville CDP, Florida

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The document is an Affidavit Regarding Labor and Services form from the Florida Department of Transportation (FDOT), effective July 1, 2024, which requires nongovernmental entities to provide an affidavit when executing, renewing, or extending a contract with a governmental entity. The affidavit mandates that the nongovernmental entity's authorized representative attest under penalty of perjury that the organization does not use coercion for labor or services as defined in §787.06, Florida Statutes. The form includes spaces for the nongovernmental entity's name, address, contact information, and requires a signature from an authorized representative along with notarization.

The affidavit is part of a broader statutory requirement aimed at preventing labor coercion and ensuring ethical contracting practices between nongovernmental and governmental entities in Florida. It serves as a legal declaration of compliance with state labor regulations, providing a formal mechanism for entities to affirm their commitment to fair and voluntary labor practices. The form must be completed and signed before contract execution, with provisions for both physical and online notarization, and includes checkboxes for personal knowledge or produced identification verification.

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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 .