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 Invitation to Bid (ITB) from the Florida Department for equipment breakdown insurance. The Department is seeking to establish a multi-year contract for this coverage, which will replace the current policy identified in the Attachment. The Department intends to make a single award to the lowest responsive and responsible Bidder, but reserves the right to make no award. The ITB requires completion of two affidavits - one stating the entity does not use coercion for labor or services, and another certifying the commodities offered have not been produced by forced labor.
The ITB does not provide details on quantities, response dates, award dates, or contract term. However, it states the Department will make the award in accordance with sections 287.057(1) and 287.022 of the Florida Statutes. No additional pricing terms, set asides, incumbent information, funding requirements, or other salient details are included in the document.
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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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