Human_Trafficking_Affidavit.docx
DOCX document 15 KB Posted
- Solicitation number
- 2026-ITB-125
- 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 use in conjunction with the McIntosh Power Plant – Heat Trace Bundle Material and Accessories procurement opportunity. The affidavit must be completed and executed by an authorized officer or representative of any nongovernmental entity seeking to execute, renew, or extend a contract with the City of Lakeland. 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 under Florida Statutes Section 787.06. The affidavit must be notarized and include the company name, authorized signature, printed name of the signatory, date of execution, and title of the authorized representative.
The affidavit serves as a compliance mechanism to prevent human trafficking in contract relationships with the City of Lakeland. Any nongovernmental entity that discovers it has engaged in coercion for labor or services at any point must immediately notify the City of Lakeland, and such violation would prevent execution, renewal, or extension of future contracts with the municipality. The form includes provisions for notarization by means of physical presence or online notarization, with space for the notary public's signature, stamp or seal, name, and commission expiration date. This affidavit is a mandatory requirement for bidders responding to the heat trace materials procurement solicitation.
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Other files
| File | Type | Posted |
|---|---|---|
| McIntosh_Power_Plant_-_Heat_Trace_Bundle_Material_and_Accessories_(Addendum_#1_Revision).pdf | ||
| McIntosh_Power_Plant_-_Heat_Trace_Bundle_Material_and_Accessories.pdf | ||
| Indemnification_2026_Contractor_-_FDOT.docx | DOCX document | |
| Indemnification_2026_Consultant_-_FDOT.docx | DOCX document | |
| PSM_-_Contractor_Audit_Form.pdf | ||
| Indemnification_2026_Vendor.doc | DOC document | |
| Indemnification_2026_Contractor.doc | DOC document | |
| Indemnification_2026_Consultant.doc | DOC 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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