Human_Trafficking_Affidavit.docx
DOCX document 15 KB Posted
- Solicitation number
- 2026-RFP-083
- Issued by
- Polk County, Florida
About this file
This is a Human Trafficking Affidavit required by the City of Lakeland, Florida for nongovernmental entities executing, renewing, or extending contracts with the municipality. The affidavit pertains to a weatherproofing, roof repairs, and coating project at Simpson Park Community Center, for which the City of Lakeland Public Works - Facilities Maintenance Division is soliciting proposals from qualified and experienced State Certified Licensed General Contractors (CGC) or Building Contractors (CBC) registered in Florida. The affidavit must be completed by an authorized officer or representative of the contracting entity and attests that the signatory is over 18 years of age with personal knowledge of the matters contained therein.
The affidavit requires the nongovernmental entity to certify that neither it nor its subsidiaries or affiliates use coercion for labor or services as defined in Section 787.06, Florida Statutes, and commits to immediately notifying the City of Lakeland should any such coercion occur in the future, which would prohibit contract execution, renewal, or extension. The document must be notarized and include the company name, authorized signature, printed name, date, title of signatory, and notary acknowledgment with commission expiration date. This affidavit is a mandatory compliance requirement under Florida law and must be submitted as part of the proposal process for the Simpson Park Community Center project.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Weatherproofing,_Roof_and_Coating_Repairs_at_Simpson_Park_Community_Center.pdf | ||
| _Simpson_Park_Comm._Center_B&C.pdf | ||
| _Simspon_Prk_C.C._Specifications_-_Bid_and_Construction.pdf | ||
| Pricing_Sheet.pdf | ||
| Indemnification_2026_Consultant.doc | DOC document | |
| PSM_-_Contractor_Audit_Form.pdf | ||
| Indemnification_2026_Consultant_-_FDOT.docx | DOCX document | |
| Indemnification_2026_Vendor.doc | DOC document | |
| Indemnification_2026_Contractor_-_FDOT.docx | DOCX 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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