Human_Trafficking_Affidavit.docx
DOCX document 15 KB Posted
- Attached to
- Drug and Alcohol Testing Services Citywide State and local contract opportunity
- Solicitation number
- 2026-RFP-072
- Issued by
- Polk County, Florida
About this file
This is a Human Trafficking Affidavit required by the City of Lakeland, Florida, for the Drug and Alcohol Testing Services Citywide contract opportunity. The affidavit must be completed and signed by an authorized officer or representative of any nongovernmental entity executing, renewing, or extending a contract with the City. The document certifies compliance with Section 787.06(14) of the Florida Statutes and requires the contracting entity to affirm that it and its subsidiaries or affiliates do not use coercion for labor or services as defined in Section 787.06 of the Florida Statutes. The affidavit obligates the nongovernmental entity to immediately notify the City if any future use of coercion for labor or services occurs, which would prevent contract execution, renewal, or extension.
The affidavit must be notarized and include the company name, authorized signature, printed name of the signatory, title, date, and notary acknowledgment. The notary section allows for either physical presence or online notarization and requires identification verification. This document serves as a compliance mechanism to ensure that all vendors contracting with the City of Lakeland meet anti-human trafficking requirements under Florida state law.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| Drug_and_Alcohol_Testing_Services_Citywide.pdf | ||
| Contractor_Safety_Evaluation_Form.pdf | ||
| Indemnification_2026_Vendor.doc | DOC document | |
| Drug-Free_Workplace_&_Mandatory_Testing_Policy_1.14.25.pdf | ||
| Indemnification_2026_Consultant.doc | DOC document | |
| EVALUATION_CRITERIA.docx | DOCX document | |
| Indemnification_2026_Consultant_-_FDOT.docx | DOCX document | |
| Indemnification_2026_Contractor_-_FDOT.docx | DOCX document | |
| References.docx | DOCX document | |
| Indemnification_2026_Contractor.doc | DOC document | |
| PSM_-_Contractor_Annual_Audit_Form.pdf | ||
| Questionnaire.docx | DOCX document |
Show all 12
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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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