Affidavit Regarding Labor & Services.pdf

PDF 407 KB Posted

Attached to
DISTRICTWIDE FENCING FOR FLORIDA DEPARTMENT OF TRANSPORTATION – DISTRICT FOUR
Solicitation number
ITB-17082
Issued by
Broward County, Fruitville CDP, Florida

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This is an Affidavit Regarding Labor and Services form issued by the Florida Department of Transportation, effective July 1, 2024, pursuant to Florida Statutes Section 787.06(13). The affidavit is required for all contracts executed, renewed, or extended between nongovernmental entities and governmental entities in Florida. The form mandates that an authorized representative of the nongovernmental entity must attest under penalty of perjury that the entity does not use coercion for labor or services as defined under Florida law. The affidavit requires completion of standard identifying information including the nongovernmental entity's name, address, phone number, authorized representative name, title, and email address.

The affidavit must be signed by the authorized representative and notarized before a notary public. Notarization can be accomplished through physical presence or online notarization, with the notary required to verify personal identification or confirm the signer is personally known. This attestation requirement applies to the Districtwide Fencing procurement for the Florida Department of Transportation District Four and represents a mandatory compliance document that must be submitted as part of the bidding process for this state contract opportunity.

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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 .