Human_Trafficking_Affidavit.docx
DOCX document 15 KB Posted
- Attached to
- Historic Districts Resurvey Phase 3
- Solicitation number
- 2026-RFP-096
- 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 in compliance with Section 787.06(14), Florida Statutes. The affidavit must be completed and notarized by an authorized officer or representative of the contracting entity prior to contract execution. The document requires the signatory to attest under penalty of perjury that the entity and its subsidiaries or affiliates do not use coercion for labor or services as defined in Florida Statutes, and obligates the entity to immediately notify the City if such coercion is used at any future time, which would prohibit contract execution, renewal, or extension between the parties.
The affidavit form requires completion of company identification, authorized signature, notarization with the date and notary information, and confirmation that the attestor has personal knowledge of the matters stated and that all facts are true. This compliance document applies to the Historic Districts Resurvey Phase 3 contract opportunity, which involves a Cultural Resource Management consultant conducting a historic resources survey of three historic districts in Lakeland and updating the Florida Master Site File with documentation for approximately 500 or more qualifying structures. Any vendor responding to this solicitation must provide a completed and notarized Human Trafficking Affidavit as part of their proposal submission.
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Other files
| File | Type | Posted |
|---|---|---|
| Historic_Districts_Resurvey_Phase_3.pdf | ||
| Indemnification_2026_Consultant.doc | DOC document | |
| Indemnification_2026_Vendor.doc | DOC document | |
| Indemnification_2026_Consultant_-_FDOT.docx | DOCX document | |
| Indemnification_2026_Contractor.doc | DOC document | |
| Proposal_Evaluation_Criteria.docx | DOCX document | |
| Indemnification_2026_Contractor_-_FDOT.docx | DOCX document | |
| PSM_-_Contractor_Audit_Form.pdf |
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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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