Affidavit Regarding Labor & Services.pdf
PDF 11 KB Posted
- 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 document issued by the Florida Department of Transportation (FDOT) for the DATA NETWORK STRUCTURED CABLING SYSTEM procurement serving FDOT District 4 and District 6. The affidavit is required under Florida Statute 787.06(13) and must be executed by all nongovernmental entities entering into, renewing, or extending contracts with FDOT effective July 1, 2024. The form requires completion of the contractor's name, address, phone number, and authorized representative information, along with a sworn attestation by the authorized representative under penalty of perjury that the entity does not use coercion for labor or services as defined in Florida law. The document must be notarized with either physical presence or digital notarization and includes spaces for notary certification with identification requirements.
This affidavit is a mandatory compliance document that all bidders for the FDOT structured cabling project must submit as part of their bid package. Failure to provide the completed and notarized affidavit will likely result in bid rejection as a non-responsive submission. The affidavit serves as a verification mechanism to ensure that FDOT contracts only with entities that maintain lawful labor practices and comply with Florida's anti-coercion 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 .