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
This document is an Affidavit Regarding Labor and Services form issued by the State of 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. The affidavit requires an authorized representative of the nongovernmental entity to attest under penalty of perjury that their organization does not use coercion for labor or services, as defined in §787.06 of the Florida Statutes.
The form provides a standardized template for companies to formally declare their compliance with labor coercion regulations, requiring the completion of key details such as the nongovernmental entity's name, address, phone number, authorized representative's name and title, and email address. The document includes spaces for the authorized representative's signature, date, and a notary public section to formally witness and validate the affidavit. This form appears to be part of FDOT's procurement process to ensure ethical labor practices among contractors and vendors seeking to do business with the state government.
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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 .