Coercion_affidavit_9.23.25.pdf
PDF 100 KB Posted
- Attached to
- Equitable Services for Private Schools
- Solicitation number
- 019-MJ-0326
- Issued by
- Polk County, Florida
About this file
This is an affidavit regarding coercion for labor and services required by the School Board of Polk County, Florida for the Equitable Services for Private Schools contract opportunity. Effective July 1, 2024, Section 787.06(13) of Florida Statutes requires all nongovernmental entities executing, renewing, or extending contracts with governmental entities to provide a signed affidavit under penalty of perjury certifying compliance with anti-coercion standards. The affidavit must be completed by an authorized representative of the vendor and notarized before a notary public. The document requires the vendor's name, address, phone number, authorized representative's name and title, and the representative's signature and declaration under penalty of perjury.
The affidavit certifies that the vendor does not engage in prohibited coercive practices including use or threat of physical force, unlawful restraint or confinement, debt-based labor schemes, document confiscation, financial harm threats, fraud-based enticement, or provision of controlled substances for exploitation purposes. Vendors must declare that all statements in the affidavit are true and complete. The notary must acknowledge the document by recording the date of acknowledgment, the authorized representative's name, whether the representative was personally known or provided identification, and the notary's state commission number and expiration date. This affidavit is a mandatory compliance document required prior to contract execution with Polk County Schools.
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Text version
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 penalty of perjury, I declare that I have read the foregoing document and that the facts stated in it are true.
Signature of Authorized Representative: ______________________________________________
The foregoing instrument was acknowledged before me this _____ day of _____, 20____, by ________________________, as Authorized Representative of the above-named Vendor who is (___) personally known to me or (____) produced a _______ driver’s license as identification.
Notary Public, State of _____________________ Commission no.: __________________________ My commission expires:____________________
File details come from the government source that posted it. Updated .