35-Human Trafficking Affidavit.pdf
PDF 49 KB Posted
- Attached to
- North Himes Avenue at West Waters Avenue
- Solicitation number
- IFB-26-00271
- Issued by
- Hillsborough County, Florida
About this file
This is a mandatory Human Trafficking Affidavit required by Hillsborough County, Florida for entities entering into, extending, or renewing contracts with the county. The affidavit requires an authorized representative of the nongovernmental entity to verify under oath that the organization does not use coercion for labor or services as defined in Florida Statutes Section 787.06. The document must be completed by an individual over eighteen years of age who holds an authorized position within the contracting entity and is empowered to provide the attestation on the organization's behalf. The affidavit is executed under penalties of perjury, with false statements subject to criminal penalties under Florida Statutes Section 837.06.
The completed affidavit must be notarized and include the notary's confirmation of the affiant's identity through either personal recognition or identification documentation. This mandatory compliance document applies to the contract opportunity for intersection improvements at North Himes Avenue at West Waters Avenue in Hillsborough County, valued at $2,594,198.34, which includes roadway widening, signal replacement, drainage improvements, ADA pedestrian improvements, and sign and pavement marking installation. The solicitation establishes a 5% Small Business Enterprise (SBE) subcontractor participation goal.
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Text version
HILLSBOROUGH COUNTY, FLORIDA
HUMAN TRAFFICKING AFFIDAVIT (MANDATORY)
As a condition of entering into, extending or renewing a contract with Hillsborough County (the “governmental entity”), the Entity (the “nongovernmental entity”) by and through its authorized representative listed below, does verify and a"irm the information below:
1. I, ______________________________________________________, am over the age of eighteen, and a"irm the following information is given from my own personal knowledge.
2. I am an authorized representative, agent, or o"icer of __________________________________________________, which is a nongovernmental entity.
3. I serve as __________________________________________________________ for the nongovernmental entity and am authorized to provide this information on behalf of the nongovernmental entity.
4. As the authorized representative, agent, or o"icer of the nongovernmental entity, I a"irm the nongovernmental entity does not use coercion for labor or services, as defined in Section 787.06, F.S. (as may be amended) and relating to human tra"icking.
5. This declaration is made pursuant to Section 837.06, F.S. (as may be amended) and I understand that making a false statement in this declaration may be subject to criminal penalties.
Under penalties of perjury, I, ________________________________________________________________ (Signature of
Representative), declare that I have read the foregoing Human Tra"icking A"idavit and that the facts stated in it are true.
Further A"iant Sayeth Not.
STATE OF __________________________________)
COUNTY OF ______________________________________________)
Sworn to (or a"irmed) and subscribed before me by means of physical presence or online notarization, this _____ day of ______________, 20 ________ by (A"iant) _____________________________________________________, whose title is __________________________________, and for the nongovernmental entity
(Signature of Notary Public)
(Print, type, or Stamp Commissioned Name of Notary Public)
Indicate whether the A"iant is:
Personally Known ___________ or Produced Identification __________
Indicate the type of Identification Produced ___________________________________________
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