PCPS_Affidavits_Regarding_the_Use_of_Coercion_for_Labor_and_Services.pdf

Affidavit Regarding the Use of Coercion for Labor and Services

State of Florida County of __________________

Name of Vendor: _____________________________________________________________________

Address: ____________________________________________________________________________

Phone Number: ______________________________________________________________________

Authorized Representative’s Name: _____________________________________________________

Authorized Representative’s Title: _______________________________________________________

Effective July 1, 2024, Section 787.06(13), Florida Statutes, requires all nongovernmental entities executing, renewing, or extending a contract with a governmental entity to provide an affidavit signed by an officer or representative under penalty of perjury attesting that the nongovernmental entity does not use coercion for labor or services.

As the person authorized to sign on behalf of the vendor, I certify that the vendor identified above does not:

• Use or threaten to use physical force against any person;

• Restrain, isolate, or confine or threaten to restrain, isolate, or confine any person without lawful authority and against her or his will;

• Use lending or other credit methods to establish a debt by any person when labor or services are pledged as a security for the debt, if the value of the labor or services as reasonably assessed is not applied toward the liquidation of the debt, the length and nature of the labor or services are not respectively limited and defined;

• Destroy, conceal, remove, confiscate, withhold, or possess any actual or purported passport, visa, or other immigration document, or any other actual or purported government identification document, of any person;

• Cause or threaten to cause financial harm to any person;

• Entice or lure any person by fraud or deceit; or

• Provide a controlled substance as outlined in Schedule I or Schedule II of Florida Statute

893.03 to any person for the purpose of exploitation of that person.

Under penalties of perjury, I declare that I have read the foregoing document and that the facts stated in it are true.

The foregoing instrument was acknowledged before me this _____ day of _____, 20____, by ____________________, as ___________of ______________ , a ________________, on behalf of the said ___________________________ who is (___) personally known to me or (____) produced a _______ driver’s license as identification.

Notary Public, State of _____________________ Commission no.: __________________________ My commission expires:____________________

Affidavit Regarding Foreign Countries of Concern

State of Florida County of __________________

Name of Vendor: _____________________________________________________________________

Address: ____________________________________________________________________________

Phone Number: ______________________________________________________________________

Authorized Representative’s Name: _____________________________________________________

Authorized Representative’s Title: _______________________________________________________

Effective January 1, 2024, Section 287.138, Florida Statutes, prohibits a Florida governmental entity from entering into a contract that may grant or allow access to any individual’s personal identifying information unless the contracting entity furnishes an affidavit signed by an officer or representative under penalty of perjury concerning foreign countries of concern.

As the person authorized to sign on behalf of the vendor, I certify that:

• The vendor is not owned by the People’s Republic of China, the Russian Federation, the Islamic Republic of Iran, the Democratic People’s Republic of Korea, the Republic of Cuba, the Venezuelan regime of Nicolás Maduro, or the Syrian Arab Republic, or by any agency of or any other entity of significant control of any of such foreign country of concern.

• The government of the People’s Republic of China, the Russian Federation, the Islamic Republic of Iran, the Democratic People’s Republic of Korea, the Republic of Cuba, the Venezuelan regime of Nicolás Maduro, or the Syrian Arab Republic does not have a controlling interest in the vendor.

• The vendor is not organized under the laws of and does not have its principal place of business in the People’s Republic of China, the Russian Federation, the Islamic Republic of Iran, the Democratic People’s Republic of Korea, the Republic of Cuba, the Venezuelan regime of Nicolás Maduro, or the Syrian Arab Republic.

Under penalties of perjury, I declare that I have read the foregoing document and that the facts stated in it are true.

The foregoing instrument was acknowledged before me this _____ day of _____, 20____, by ____________________, as ___________of ______________ , a ________________, on behalf of the said ___________________________ who is (___) personally known to me or (____) produced a _______ driver’s license as identification.

Notary Public, State of _____________________ Commission no.: __________________________ My commission expires:____________________