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 a State of Florida Invitation to Bid (ITB) for Equipment Breakdown Insurance. The Department is seeking to establish a multi-year contract to replace its current policy. The contract will be awarded to the lowest responsive and responsible bidder, but the Department reserves the right to make no award. The document contains two parts: Part A requires the bidder to certify that they do not use coercion for labor or services, and Part B requires the bidder to certify that the commodities offered have not been produced by forced labor.
The document does not provide additional details on pricing terms, set-asides, incumbents, funding requirements, or other salient information related to the contract opportunity.
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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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