Human_Trafficking_Affidavit.docx
DOCX document 15 KB Posted
- Attached to
- Annual Supply and Delivery of Concrete
- Solicitation number
- 2026-ITB-105
- 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) of the Florida Statutes, for any nongovernmental entity executing, renewing, or extending a contract with the municipality. The affidavit applies to the Annual Supply and Delivery of Concrete contract, which requires the contractor to furnish and deliver an estimated annual supply of 3,000 psi blend mix, class 1 2,500 NS, and excavatable flow-fill concrete materials in accordance with Florida Department of Transportation standard specifications for road and bridge construction (2025 edition, sections 344, 346, and 347). The concrete will support the City of Lakeland Public Works Construction and Maintenance Division and other city departments as needed. The estimated annual quantity requirement is approximately 1,000 cubic yards for bidding purposes, though this represents an approximation based on prior usage and is not a guaranteed purchase quantity. The contract term runs through September 30, 2027, with four optional one-year renewal periods available upon mutual consent.
The affidavit requires an authorized officer or representative of the bidding 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 Florida Statutes Section 787.06. The affiant must certify they have personal knowledge of the matters and are authorized to execute the document on behalf of the entity. The affidavit must be notarized and includes provisions requiring the entity to immediately notify the City of Lakeland if any future use of coercion occurs, which would prohibit contract execution, renewal, or extension. All parties executing this document must be at least 18 years of age and complete the certification before a notary public via physical presence or online notarization.
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Other files
| File | Type | Posted |
|---|---|---|
| Annual_Supply_and_Delivery_of_Concrete.pdf | ||
| PSM_-_Contractor_Audit_Form.pdf | ||
| Indemnification_2026_Contractor_-_FDOT.docx | DOCX document | |
| Indemnification_2026_Vendor.doc | DOC document | |
| Indemnification_2026_Consultant.doc | DOC document | |
| Indemnification_2026_Contractor.doc | DOC document | |
| Indemnification_2026_Consultant_-_FDOT.docx | DOCX 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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