Human_Trafficking_Affidavit.docx
DOCX document 15 KB Posted
- Solicitation number
- 2026-RFQ-076
- 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), Florida Statutes, for a continuing contract for Professional Environmental Risk Engineering Services. The affidavit must be completed and executed by an authorized officer or representative of any nongovernmental entity entering into, renewing, or extending a contract with the City of Lakeland. The contract opportunity is being pursued under the State of Florida Consultant's Competitive Negotiation Act (CCNA) and will result in an initial three-year contract term with an option for two additional one-year renewals upon mutual consent between the parties.
The affidavit requires the executing officer 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 Statutes Section 787.06. The signatory must confirm personal knowledge of the matters stated and authorize the affidavit on behalf of the entity. The document must be notarized either through physical presence or online notarization, with the notary public providing signature, seal or stamp, name, and commission expiration date. The affidavit obligates the entity to immediately notify the City of Lakeland if it engages in coercion for labor or services in the future, which would prevent execution, renewal, or extension of any subsequent contracts between the parties.
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Other files
| File | Type | Posted |
|---|---|---|
| Continuing_Contract_for_Professional_Environmental_Risk_Engineering_Services_(CCNA).pdf | ||
| Continuing_Contract_for_Professional_Environmental_Risk_Engineering_Services_template_2026_Example.docx | DOCX document | |
| Indemnification_2026_Contractor.doc | DOC document | |
| PSM_-_Contractor_Annual_Audit_Form.pdf | ||
| Selection_Committee_for_Environmental_Risk_Engineering_Service_2026.docx | DOCX document | |
| Indemnification_2026_Contractor_-_FDOT.docx | DOCX document | |
| 3-_Score_Sheet_for_RFQ#_1210A_Envir_Risk_Engineering_2026.xlsx | XLSX spreadsheet | |
| Contractor_Safety_Evaluation_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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