9-Human Trafficking Affidavit.pdf
PDF 47 KB Posted
- Solicitation number
- RPS-25-00264
- Issued by
- Hillsborough County, Florida
About this file
This document is a Human Trafficking Affidavit from Hillsborough County, Florida, which is a mandatory form for nongovernmental entities entering into, extending, or renewing a contract with the county. The form requires an authorized representative of a nongovernmental entity to affirm that they are over 18 years old and that their organization does not use coercion for labor or services, as defined in Section 787.06, F.S., relating to human trafficking.
The affidavit must be signed under penalties of perjury and requires notarization, with the signatory declaring that the statements made are true. The document provides spaces for the representative to fill in their personal information, their role in the organization, and the name of the nongovernmental entity. The form also includes sections for a notary public to complete, including verifying the identity of the affiant through personal knowledge or produced identification.
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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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