Human_Trafficking_Affidavit.docx
DOCX document 15 KB Posted
- Attached to
- Joint Use Pole Audit State and local contract opportunity
- Solicitation number
- 2026-RFP-054
- 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 municipality. The affidavit must be completed and notarized by an authorized officer or representative of the contracting entity. The document pertains to a Joint Use Pole Audit project for Lakeland Electric (LE), which encompasses approximately 80,789 City of Lakeland-owned poles (excluding decorative and aluminum light poles and poles at the power plant) that require auditing as of early 2025. The audit addresses the approximately 94,430 total poles within LE's service territory, which includes poles owned by the City of Lakeland, Florida Department of Transportation, TECO, and Verizon.
The affidavit requires the nongovernmental entity to attest under penalty of perjury that it and its subsidiaries or affiliates do not use coercion for labor or services as defined in Section 787.06, Florida Statutes. The entity must commit to immediately notifying the City of Lakeland should any future violations occur, with the understanding that such violations would prevent contract execution, renewal, or extension. The affidavit must be notarized by a notary public and include the signatory's company name, title, printed name, signature, and date, along with the notary's signature, commission expiration date, and official seal or stamp.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| Joint_Use_Pole_Audit_(Addendum_#2_Revision).pdf | ||
| Joint_Use_Pole_Audit_Scope_2026_06_10.pdf | ||
| 2026_City_of_Lakeland_Standard_Contract_Form.pdf | ||
| Contractor_Safety_Evaluation_Form.pdf | ||
| Indemnification_2026_Contractor.doc | DOC document | |
| Indemnification_2026_Contractor_-_FDOT.docx | DOCX document | |
| PSM_-_Contractor_Annual_Audit_Form.pdf | ||
| Indemnification_2026_Consultant.doc | DOC document | |
| Indemnification_2026_Consultant_-_FDOT.docx | DOCX document | |
| Indemnification_2026_Vendor.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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