Affidavit Regarding Labor & Services.pdf
PDF 8 KB Posted
- Attached to
- Districtwide Office of Modal Development Special Project Communication & Outreach – Florida Departme
- Solicitation number
- RFP-16724
- Issued by
- Broward County, Graceville City, Florida
About this file
This is an Affidavit Regarding Labor and Services form issued by the Florida Department of Transportation effective July 1, 2024, in accordance with Florida Statutes Section 787.06(13). The affidavit must be executed by all nongovernmental entities entering into, renewing, or extending contracts with the Florida Department of Transportation. The form requires completion of entity identification information including the nongovernmental entity's name, address, phone number, authorized representative name and title, and email address. The authorized representative must attest under penalty of perjury that the nongovernmental entity does not use coercion for labor or services as defined in Florida Statutes Section 787.06.
The affidavit requires notarization before a notary public, though digital notarization is permitted. The notary must verify the authorized representative's identity through personal recognition or by examination of identification documents and record the identification type. This requirement applies to all contractors bidding on the Districtwide Office of Modal Development Special Projects Communication and Outreach procurement opportunity issued by the Florida Department of Transportation District 4, and completion of the affidavit is a mandatory condition of contract execution, renewal, or extension with the state.
View the file
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| 6-Exhibit C-2 - MFMP Transaction Fee.pdf | ||
| Attached Forms.pdf | ||
| 3-Exhibit A - Scope of Services.pdf | ||
| 4-Exhibit B- Method of Compensation (Sample).pdf | ||
| 1-Q&A No. 1.pdf | ||
| PUR1355.pdf | ||
| 5-Exhibit C-1- Price Proposal Form.xlsx | XLSX spreadsheet | |
| 2-Standard Written Agreement (Sample).pdf | ||
| 1-Request For Proposal (Shell).pdf |
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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 .