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 an Invitation to Bid (ITB) issued by the Florida Department of [agency/department] for Equipment Breakdown Insurance. The Department intends to make a single award to the lowest responsive and responsible Bidder for a multi-year contract, though they reserve the right to make no award. The ITB requires completion of two forms: one certifying that the entity does not use coercion for labor or services, and another certifying that the commodities offered have not been produced using forced labor.
The ITB seeks to replace the Department's current equipment breakdown insurance policy, as identified in the solicitation. No other details about the project scope, quantities, or timeline are provided. The contract term and any renewal options are also not specified.
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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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