Human_Trafficking_Affidavit.docx
DOCX document 15 KB Posted
- Attached to
- Drug and Alcohol Testing Services Citywide
- Solicitation number
- 2026-RFP-045
- Issued by
- Polk County, Florida
About this file
This is a Human Trafficking Affidavit form required by the City of Lakeland, Florida, for nongovernmental entities executing, renewing, or extending contracts with the City in compliance with Section 787.06(14), Florida Statutes. The affidavit applies to the Drug and Alcohol Testing Services Citywide contract opportunity, which seeks a qualified firm to provide comprehensive drug and alcohol screening services for all City departments and work locations in accordance with the Florida Drug-Free Workplace Act. The City requires the selected firm to provide DOT and Non-DOT drug screens, DOT and Non-DOT alcohol testing, on-site after-hours testing, on-site random testing, and random selection process administration while adhering to the City's Drug-Free Workplace & Mandatory Testing Policy. The contract may also be available to other qualified public agencies throughout Florida under the Florida Interlocal Cooperation Act of 1969.
The affidavit requires an authorized officer or representative of the proposing nongovernmental entity to attest under penalty of perjury that the entity and its subsidiaries or affiliates do not use coercion for labor or services as defined in Florida Statutes Section 787.06, and to commit to immediately notifying the City if such coercion occurs in the future, which would prevent contract execution, renewal, or extension. The completed affidavit must include the company name, authorized signature, printed name, title, date, and notarization by a notary public. Award of the contract will be based on best value to the City rather than price alone, with the selection committee evaluating proposals according to competitive selection criteria established by the City.
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Other files
| File | Type | Posted |
|---|---|---|
| Drug_and_Alcohol_Testing_Services_Citywide_(Addendum_#3_Revision).pdf | ||
| Drug-Free_Workplace_&_Mandatory_Testing_Policy_1.14.25.pdf | ||
| PSM_-_Contractor_Annual_Audit_Form.pdf | ||
| Contractor_Safety_Evaluation_Form.pdf | ||
| Questionnaire.docx | DOCX document | |
| EVALUATION_CRITERIA.docx | DOCX document | |
| References.docx | DOCX document | |
| Indemnification_2026_Contractor_-_FDOT.docx | DOCX document | |
| Indemnification_2026_Consultant_-_FDOT.docx | DOCX document | |
| Indemnification_2026_Vendor.doc | DOC document | |
| Indemnification_2026_Consultant.doc | DOC document | |
| Indemnification_2026_Contractor.doc | DOC document |
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Text version
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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