EB 24-64121502-ITB Attachment N PUR 2024.pdf
PDF 119 KB Posted
- Attached to
- Equipment Breakdown Insurance
- Solicitation number
- ITB-09962
- Issued by
- Palm Beach County, Florida
About this file
This document is an attachment to Solicitation No. 24-64121502-ITB, issued by the State of Florida, related to the procurement of Equipment Breakdown Insurance. The attachment contains two parts: Part A, which requires the contractor to certify that they do not use coercion for labor or services as defined in Section 787.06 of the Florida Statutes, and Part B, which requires the contractor to certify that the commodities being offered have not been produced, in whole or in part, by forced labor, as defined in Section 287.1346 of the Florida Statutes. The contractor must complete and sign both parts of the attachment as part of their submission for the solicitation.
The document does not provide any additional details about the solicitation, such as the project overview, item quantities, response dates, or term of the contract. It focuses solely on the contractor's certification regarding the use of coercion and forced labor in the provision of the commodities or services.
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Text version
Solicitation No. 24-64121502-ITB Equipment Breakdown Insurance
Attachment N
PUR 2024
Part A: Use of Coercion for Labor and Services
Pursuant to section 787.06(13), Florida Statutes, this portion of the form must be completed by an officer or representative of the nongovernmental entity executing, renewing, or extending a contract with a governmental entity.
Name of entity does not use coercion for labor or services as defined in section 787.06, Florida Statutes.
Under penalties of perjury, I declare that I have read the foregoing statement and that the facts stated in it are true.
Entity Name:
Representative/Officer’s Printed Name:
Representative/Officer’s Title:
Signature: Date:
Part B: Provision of Commodities Produced by Forced Labor
Pursuant to section 287.1346(4)(b), Florida Statutes, this portion of the form must be completed by a member of the company’s senior management, as defined in section 287.1346, F.S., when the company submits a response to a solicitation for the provision of commodities and before the company enters into or renews a contract for the provision of commodities.
I certify that to the best of my knowledge, the commodities Name of entity is offering to the Department have not been produced, in whole or in part, by forced labor.
Entity Name:
Senior Management’s Printed Name:
Senior Management member’s Title:
Signature: Date:
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