Human_Trafficking_Affidavit.docx
DOCX document 15 KB Posted
- Attached to
- Terminal Hold Room Expansion
- Solicitation number
- 2026-ITB-085
- Issued by
- Polk County, Florida
About this file
This is a Human Trafficking Affidavit required by the City of Lakeland, Florida, in compliance with Section 787.06(14), Florida Statutes, for nongovernmental entities executing, renewing, or extending contracts with the municipality. The affidavit must be completed and signed by an authorized officer or representative of the contracting entity. The document certifies that the nongovernmental entity and its subsidiaries or affiliates do not use coercion for labor or services as defined under Florida Statutes, and obligates the entity to immediately notify the City of Lakeland should any such activity occur in the future, with the understanding that failure to comply will prohibit execution, renewal, or extension of contracts between the parties.
The affidavit requires the signatory to attest under penalty of perjury that they are over 18 years of age with personal knowledge of the matters stated, and that they are authorized to execute the document on behalf of the entity. The completed affidavit must include the company name, authorized signature, printed name of the signatory, date, and title. Additionally, the document must be notarized, with the notary public acknowledging the affiant's identity either through physical presence or online notarization and affixing their official seal or stamp to the instrument.
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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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