Human_Trafficking_Affidavit.docx
DOCX document 15 KB Posted
- Attached to
- ANNUAL 69KV CIRCUIT BREAKER MULTI-YEAR AGREEMENT
- Solicitation number
- 2026-ITB-127
- 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) of the Florida Statutes. The affidavit applies to the Annual 69kV Circuit Breaker Multi-Year Agreement, a one-year contract for the purchase of 69kV circuit breakers with options for four additional one-year renewals, not to exceed five years total. The specification requires three-phase, 60 Hz circuit breakers designed for outdoor use on solidly grounded systems with a maximum line-to-line voltage of 72.5 kV, featuring three-pole gang tripping and closing capabilities. Two part numbers are specified: Part #1092690 (Circuit Breaker 69kV 2000A 48VDC) and Part #1092691 (Circuit Breaker 69kV 2000A 125VDC). The breakers must utilize sulfur hexafluoride gas and/or vacuum as the dielectric and interrupting medium, contained within a grounded metal tank using dead tank construction.
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 Florida Statutes. The signatory must confirm personal knowledge of the attestation and agree to immediately notify the City of Lakeland if any coercion practices occur in the future, which would preclude contract execution, renewal, or extension. The affidavit must be notarized and include the company name, authorized signature, printed name, title, date, and notary information. The contract may be used by other City of Lakeland departments as applicable, and individual purchase orders will reference the specified part numbers and descriptions.
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Other files
| File | Type | Posted |
|---|---|---|
| ANNUAL_69KV_CIRCUIT_BREAKER_MULTI-YEAR_AGREEMENT.pdf | ||
| SUB-CB-069-T-1.pdf | ||
| PSM_-_Contractor_Audit_Form.pdf | ||
| Indemnification_2026_Vendor.doc | DOC document | |
| Indemnification_2026_Contractor.doc | DOC document | |
| Indemnification_2026_Contractor_-_FDOT.docx | DOCX document | |
| Indemnification_2026_Consultant.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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