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Bid Title: Motor Coach Transportation Bid No. FY23-029-1 <br />The School Board of Broward County, Florida Page 24 of 26 <br />ATTACHMENT F - WORKERS' COMPENSATION AFFIDAVIT <br />THE SCHOOL BOARD OF BROWARD COUNTY, FLORIDA <br />WORKERS' COMPENSATION AFFIDAVIT <br />CERTIFICATION OF NUMBER OF EMPLOYEES <br />(Bidder Name) hereby certifies and affirms that the entity named herein has <br />less than four (4) employees nor uses any subcontractor(s) with four (4) or more employees and will not have four <br />(4) or more employees during the term of this agreement. <br />I further certify that, if during the period covered by this affidavit the entity named herein becomes an employer with <br />four (4) or more employees or uses subcontractor(s) with four (4) or more employees, a Certificate of Insurance <br />shall be provided to The School Board of Broward County, Florida, within five (5) business days. <br />With respect to the construction industry, all employment in which one or more employees are employed shall <br />provide evidence of Workers' Compensation coverage. <br />Signed: <br />Print/Type Name: <br />Title: <br />Sworn to and subscribed before me this day of , <br />Notary Public Signed: <br />Notary Public Print: <br />Notary Stamp Below: <br />Broward County Public Schools Is An Equal Opportunity/Equal Access Employer <br />Page 24 <br />