Human_Trafficking_Affidavit.docx
DOCX document 15 KB Posted
- Solicitation number
- 2026-RFP-007
- Issued by
- Polk County, Florida
About this file
This is a Human Trafficking Affidavit form required by the City of Lakeland, Florida, in compliance with Section 787.06(14) of the Florida Statutes, for use by nongovernmental entities executing, renewing, or extending contracts with the municipal government. The affidavit must be completed and signed by an authorized officer or representative of the contracting entity and notarized before a notary public. The document requires the signing party to attest under penalty of perjury that the nongovernmental entity and its subsidiaries or affiliates do not use coercion for labor or services as defined in Florida law, and commits the entity to immediately notify the City should any future violations occur. The form includes standard notarization sections requiring physical presence or online notarization, with space for the notary public's signature, stamp or seal, commission expiration date, and identification of the signatory.
The affidavit serves as a mandatory compliance document for contractors bidding on the City of Lakeland's RFP 2026-RFP-007 for an independent evaluation of Lakeland Electric's Operational Technology network and NERC CIP compliance assessment. Bidders must submit the completed and notarized affidavit as part of their proposal package, along with other required compliance documents including indemnification agreements, non-disclosure agreements, and contractor safety evaluation forms. Failure to provide a properly executed human trafficking affidavit may render a proposal non-responsive and result in disqualification from consideration for contract award.
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HUMAN TRAFFICKING AFFIDAVIT
In compliance with Section 787.06(14), Florida Statutes, this Affidavit must be completed by an officer or representative of a nongovernmental entity that is executing, renewing, or extending a contract with the City of Lakeland, Florida (the “Governmental Entity”).
The undersigned, on behalf of the entity listed below (the “Nongovernmental Entity”), hereby attests under penalty of perjury as follows:
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_________________________, a Nongovernmental entity and I am authorized to provide this affidavit on behalf of Nongovernmental Entity.
3. Nongovernmental Entity, and any of its subsidiaries or affiliates, do not use coercion for labor or services, as those terms are defined in Section 787.06, Florida Statutes, as may be amended from time to time.
4. If, at any time in the future, Nongovernmental Entity does use coercion for labor or services, Nongovernmental Entity will immediately notify Governmental Entity and no contracts may be executed, renewed, or extended between the parties.
5. I have read the foregoing affidavit and confirm that the facts stated in it are true, and are made for the benefit of, and reliance by Governmental Entity.
Company: _______________________________________________ Authorized Signature: _____________________________________ Printed Name:____________________________________________ Date:______________________ 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 company/corporation. 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:______________________
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