Affidavit Regarding Labor & Services.pdf

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Attached to
DISTRICTWIDE CONTAMINATION ASSESSMENT & REMEDIATION SERVICES FOR FLORIDA DEPARTMENT OF TRANSPORTATIO
Solicitation number
RFP-13009
Issued by
Broward County, Graceville City, Florida

About this file

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This document is an Affidavit Regarding Labor and Services form issued by the Florida Department of Transportation (FDOT), effective July 1, 2024. The form is a mandatory legal document that nongovernmental entities must complete when executing, renewing, or extending a contract with a governmental entity. Specifically, the affidavit requires an authorized representative of the nongovernmental entity to attest, under penalty of perjury, that the organization does not use coercion for labor or services as defined in §787.06 of Florida Statutes.

The form provides a template for nongovernmental entities to fill out, including spaces for the entity's name, address, contact information, and authorized representative details. The affidavit must be signed by the authorized representative and notarized, with options for physical presence or online notarization. This document serves as a legal safeguard to ensure that contractors and service providers are operating ethically and without exploitative labor practices when engaging in contracts with governmental entities in the state of Florida.

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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 .