Exhibit_G-_Human_Trafficking_Form_(AFFIDAVIT).pdf
PDF 143 KB Posted
- Attached to
- Traffic Data Collection Services
- Solicitation number
- IFB-5216-26/AES
- Issued by
- Seminole County, Florida
About this file
This is a Human Trafficking Affidavit form required for a Traffic Data Collection Services contract opportunity in Florida. The affidavit serves as a compliance document pursuant to section 787.06 of the Florida Statutes, mandating that nongovernmental entities bidding on or entering into contracts with the county certify their adherence to anti-human trafficking standards. The form requires an authorized officer or representative of the bidding entity to declare under penalty of perjury that neither the entity nor its subsidiaries or affiliates use coercion for labor or services as defined in Florida law. The affidavit must be notarized by a qualified notary public and includes verification of the signatory's identity through either physical presence or online notarization.
The affidavit constitutes a mandatory certification requirement for contract eligibility, with false statements subject to criminal penalties under section 92.525 of the Florida Statutes. All prospective contractors must complete and submit this form as part of their bid package for the county's traffic data collection services contract, which is offered on an as-needed basis for the agreement duration. The form includes standard notarization elements requiring the notary to affix their stamp or seal, print their name, and document their commission expiration date, ensuring the document's legal validity and compliance with Florida notarization requirements.
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Text version
H UM AN T RAF F I CK I N G AF F I DA VI T
CONTRACT # ____________________________
In compliance with section 787.06, Florida Statutes, the undersigned, on behalf of the Nongovernmental Entity identified herein, hereby declares, under penalty of perjury, that the following facts stated herein are true:
1. I am over the age of 18 and I have personal knowledge of the matters set forth herein.
2. I am an officer or representative of (“Nongovernmental Entity”) and authorized to provide this affidavit on its behalf.
3. Neither Nongovernmental Entity, nor any of its subsidiaries or affiliates, use coercion for labor or services, as those terms are defined in section 787.06, Florida Statutes, as may be amended.
4. This declaration is made pursuant to section 92.525, Florida Statutes. I acknowledge and understand that making a false statement in this declaration may subject me to criminal penalties.
Signature Date
Print Name, Title
STATE OF
COUNTY OF
The foregoing instrument was acknowledged before me by means of ☐ physical presence or ☐ online notarization, this day of , 20 , by______________________, as ________________________, on behalf of the Nongovernmental Entity. They ☐ are personally known to me or ☐ have produced as identification.
Notary Public Signature (Affix Notary Stamp or Seal) Print, Type or Stamp Name of Notary:
My commission expires:
| H UM AN T RAF F I CK I N G AF F I DA VI T |
| CONTRACT # ____________________________ |
File details come from the government source that posted it. Updated .