Exhibit_E.pdf
PDF 521 KB Posted
- Attached to
- Wastewater Pump Station R & R
- Solicitation number
- CC-7100-26/HSM (A)
- Issued by
- Seminole County, Florida
About this file
This is an ADA Affidavit form required by Seminole County Board of County Commissioners for contractors and consultants bidding on the Wastewater Pump Station R & R project (CC-7100-26/HSM (A)). The affidavit serves as a sworn statement in which the contractor certifies compliance with the Americans with Disabilities Act (ADA), 42 USC § 12101 et seq., and affirms non-discrimination against employees or applicants based on physical or mental handicap. The document requires the contractor's signature, printed name, title, and date, along with notarization by a commissioned notary public who must verify the signatory's identity through either personal knowledge or identification documentation.
The affidavit establishes that the contractor agrees to hold harmless and indemnify Seminole County, its agents, officers, and employees from any claims, demands, debts, liabilities, or causes of action resulting from the contractor's acts or omissions related to ADA compliance. The county assumes no liability for the contractor's or any other party's failure to comply with ADA requirements. Contractors must complete and submit this executed affidavit as part of their bid documentation, with notarization required to validate the sworn statement. This form is a mandatory compliance document for all prospective bidders on this county solicitation.
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Text version
00310 – ADA Affidavit (Rev 06/2021)
AMERICANS WITH DISABILITIES ACT AFFIDAVIT
The undersigned CONTRACTOR/CONSULTANT swears that the information herein contained is true and correct and that none of the information supplied was for the purpose of defrauding the
COUNTY.
The CONTRACTOR/CONSULTANT will not discriminate against any employee or applicant for employment because of physical or mental handicap in regard to any position for which the employee or applicant for employment is qualified. The CONTRACTOR/CONSULTANT agrees to comply with the rules, regulations and relevant orders issued pursuant to the Americans with
Disabilities Act (ADA), 42 USC s. 12101 et seq. It is understood that in no event shall the
COUNTY be held liable for the actions or omissions of the CONTRACTOR/CONSULTANT or any other party or parties to the Agreement for failure to comply with the ADA. The
CONTRACTOR/CONSULTANT agrees to hold harmless and indemnify the COUNTY, its agents, officers, or employees from any and all claims, demands, debts, liabilities or causes of action of every kind or character, whether in law or equity, resulting from the
CONTRACTOR/CONSULTANT’s acts or omissions in connection with the ADA.
CONTRACTOR:
Signature:
Printed Name:
Title:
Date:
Affix Corporate Seal (if applicable)
STATE OF __________________
COUNTY OF
Sworn to (or affirmed) and subscribed before me by means of □ physical presence or □ online notarization, this day of , 20 , by .
(name of person making statement)
Signature of Notary Public
Print/Type/Stamp Commissioned Name of Notary Public
Personally Known OR Produced Identification
Type of Identification Produced:
EXHIBIT E
| CONTRACTOR: |
| Printed Name: |
| Title: |
| Date: |
| STATE OF: |
| COUNTY OF: |
| Sworn to or affirmed and subscribed before me by means of: Off |
| physical presence or: Off |
| notarization this: |
| day of: |
| by: |
| PrintTypeStamp Commissioned Name of Notary Public: |
| Personally Known: |
| OR: |
| Type of Identification Produced: |
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