Human_Trafficking_Affidavit.docx
DOCX document 15 KB Posted
- Solicitation number
- 2026-RFP-106
- Issued by
- Polk County, Florida
About this file
This is a Human Trafficking Affidavit form required by the City of Lakeland, Florida for nongovernmental entities executing, renewing, or extending contracts with the municipality. The affidavit applies to the Annual Pump Services for Flowable Concrete and Flow-Fill contract opportunity, which seeks responsible contractors to provide pump services on an as-needed basis. The resulting agreement is firm and valid from October 1, 2026, through September 30, 2027, with four (4) one-year renewal options. The City intends to award the contract to two contractors: a Primary Contractor (highest-ranked respondent) and a Secondary Contractor (second-ranked respondent). The Primary Contractor will be responsible for all specified tasks and serve as the primary provider for pump services, while the Secondary Contractor may be engaged if the Primary Contractor cannot meet service timeframes, if rates are deemed unreasonable, if obligations are not fulfilled, or to obtain more competitive rates for larger assignments.
The affidavit requires an authorized officer or representative of the nongovernmental entity 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 Section 787.06, Florida Statutes. The affiant must confirm personal knowledge of the matters stated and commit to immediately notifying the City if any future use of coercion for labor or services occurs, which would prevent contract execution, renewal, or extension. The form requires the affiant's signature, printed name, title, company name, and date, along with notarization by a notary public who verifies the affiant's identity through physical presence or online notarization.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Annual_Pump_Services_for_Flowable_Concrete_and_Flow-Fill.pdf | ||
| Indemnification_2026_Consultant_-_FDOT.docx | DOCX document | |
| Indemnification_2026_Contractor.doc | DOC document | |
| Indemnification_2026_Consultant.doc | DOC document | |
| Indemnification_2026_Contractor_-_FDOT.docx | DOCX document | |
| Indemnification_2026_Vendor.doc | DOC 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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