Form 5 - PUR 2024 Use of Coercion.pdf
PDF 401 KB Posted
- Attached to
- American Sign Language Interpretation
- Solicitation number
- ITB-12692
- Issued by
- Leon County, Florida
About this file
This document is Form 5 (PUR 2024) for ITB-DEM-24-25-019, a solicitation for American Sign Language Interpretation Services issued by a Florida governmental entity. The form is a mandatory compliance document requiring vendors to certify they do not engage in labor coercion or use forced labor in the production of commodities they are offering to the Department. The form is divided into two parts: Part A addresses the use of coercion for labor and services under section 787.06(13) of Florida Statutes, and Part B addresses the provision of commodities produced by forced labor under section 287.1346(4)(b) of Florida Statutes.
The form requires an officer or representative of the nongovernmental entity to declare, under penalties of perjury, that they do not use coercion for labor or services, and a senior management member to certify that the commodities being offered have not been produced by forced labor. While the form does not provide detailed procurement information, it is a critical compliance document that must be completed when submitting a response to a solicitation or entering/renewing a contract with a governmental entity in Florida, specifically related to American Sign Language Interpretation Services.
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Text version
ITB-DEM-24-25-019
Form 5
PUR 2024
ITB-DEM-24-25-019 American Sign Language Interpretation Services
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.
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 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:
| Entity Name: |
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| Entity Name_2: |
| Senior Managements Printed Name: |
| Senior Management members Title: |
| Text8: |
| Text10: |
| Name of entity: |
| Name of Entity: |
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