FORM 10 - PUR 2023 and PUR 2024 Combined.pdf
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- Solicitation number
- ITN-17169
- Issued by
- Palm Beach County, Florida
About this file
This file is a certification form (Form 10) issued by the Florida Department of Corrections in conjunction with a state contract solicitation for the operation and management of the South Bay Correctional Facility. The form contains two separate certification requirements that must be completed by authorized representatives of any vendor responding to this Invitation to Negotiate (ITN). Under PUR 2024, a designated officer or representative of the nongovernmental entity must certify under penalty of perjury that the company does not use coercion for labor or services as defined in Florida Statutes section 787.06. The form requires the entity name, representative's printed name, title, signature, and date. Interested vendors must submit responses through the MyFloridaMarketPlace Sourcing Event via the SAP Business Network, with all inquiries directed to Procurement Officer Sharita Newman at the Florida Department of Corrections in Tallahassee.
The PUR 2023 portion of the form requires certification by a member of senior management, as defined in Florida Statutes section 287.1346, that any commodities being offered for provision to the Department have not been produced, in whole or in part, by forced labor. Senior management is defined to include chief executive officers, assistant chief executive officers, chief financial officers, chief personnel officers, and employees performing similar functions. This certification must be completed when the company submits a response to the solicitation and before entering into or renewing any contract for commodity provision. The form requires the entity name, senior management member's printed name, title, signature, and date. Both certifications are mandatory compliance requirements for contract eligibility.
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Text version
PUR 2024: Use of Coercion for Labor or Services
Pursuant to section 787.06(14), 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.
The entity named below 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:
PUR 2023: 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.
As defined in section 287.1346(c), Florida Statutes, “Senior management” includes chief executive officers;
assistant chief executive officers, including, but not limited to, assistant presidents, vice presidents, or assistant treasurers; chief financial officers; chief personnel officers; or any employee of an entity performing similar functions.
I certify that to the best of my knowledge, the commodities the entity named below 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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