Human_Trafficking_Affidavit.docx
DOCX document 15 KB Posted
- Attached to
- Annual 15KV CIRCUIT BREAKER MULTI-YEAR AGREEMENT
- Solicitation number
- 2026-ITB-126
- Issued by
- Polk County, Florida
About this file
This is a Human Trafficking Affidavit required by the City of Lakeland, Florida for any nongovernmental entity executing, renewing, or extending a contract with the municipality. The affidavit, mandated under Section 787.06(14) of Florida Statutes, applies to the Annual 15KV Circuit Breaker Multi-Year Agreement, which constitutes a one-year contract for the purchase of Magnetically Actuated 15kV Circuit Breakers with options for four additional one-year renewals upon mutual consent, for a potential total contract term not to exceed five years. The specification package covers four part numbers of 15kV vacuum interrupter circuit breakers with varying amperage and voltage ratings (1200A and 2000A at 125VDC and 48VDC). The contract may be utilized by other City of Lakeland departments as applicable.
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, and to commit to immediate notification to the City should any such coercion occur in the future. The affidavit must be notarized before a notary public who verifies the identity of the signatory through physical presence or online notarization. No pricing terms, set-asides, incumbent information, or funding sources are detailed in the affidavit document itself, as it serves solely as a compliance certification mechanism for contract eligibility.
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Other files
| File | Type | Posted |
|---|---|---|
| Annual_15KV_CIRCUIT_BREAKER_MULTI-YEAR_AGREEMENT.pdf | ||
| SUB-CB-012-T-1.pdf | ||
| Indemnification_2026_Consultant_-_FDOT.docx | DOCX document | |
| PSM_-_Contractor_Audit_Form.pdf | ||
| Indemnification_2026_Consultant.doc | DOC document | |
| Indemnification_2026_Contractor.doc | DOC document | |
| Indemnification_2026_Vendor.doc | DOC document | |
| Indemnification_2026_Contractor_-_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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