Human_Trafficking_Affidavit.docx
DOCX document 15 KB Posted
- Solicitation number
- 2026-ITB-124
- Issued by
- Polk County, Florida
About this file
This is a Human Trafficking Affidavit form required by the City of Lakeland, Florida, for the McIntosh Unit 5 – 60-Inch Circulating Water Motor Operated Valve Replacement contract opportunity. The affidavit must be completed and notarized by an officer or authorized representative of any nongovernmental entity executing, renewing, or extending a contract with the City of Lakeland. The form certifies compliance with Section 787.06(14) of the Florida Statutes and 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 law. The affidavit includes provisions requiring the nongovernmental entity to immediately notify the City of Lakeland should any future violations occur, which would prevent execution, renewal, or extension of subsequent contracts.
The affidavit requires completion of company identification, authorized signature, printed name, date, and title fields, followed by notarization with either physical presence or online notarization. The notary section requires specification of the date, state, county, notary signature with stamp or seal, notary name and commission expiration date, and confirmation of the signatory's identity through either personal knowledge or produced identification. This document is a mandatory compliance filing for the valve replacement procurement and must be submitted as part of the bid response package.
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Other files
| File | Type | Posted |
|---|---|---|
| McIntosh_Unit_5_–_60-Inch_Circulating_Water_Motor_Operated_Valve_Replacement.pdf | ||
| SKM_C361i26081115080.pdf | ||
| SKM_C361i26081115210.pdf | ||
| COL_Purchase_Order_Ts&Cs.pdf | ||
| SKM_C361i26081115081.pdf | ||
| PSM_-_Contractor_Audit_Form.pdf | ||
| Indemnification_2026_Consultant_-_FDOT.docx | DOCX document | |
| Indemnification_2026_Contractor_-_FDOT.docx | DOCX document | |
| Indemnification_2026_Contractor.doc | DOC document | |
| Indemnification_2026_Consultant.doc | DOC document | |
| Indemnification_2026_Vendor.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:______________________
File details come from the government source that posted it. Updated .