Human_Trafficking_Affidavit.docx
DOCX document 15 KB Posted
- Solicitation number
- 2026-RFQ-119
- 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. The affidavit must be completed by an authorized officer or representative of the contractor and signed under penalty of perjury. The document serves as attestation that the nongovernmental entity and its subsidiaries or affiliates do not use coercion for labor or services as defined in Section 787.06 of the Florida Statutes. The affidavit applies to the City of Lakeland's Request for Qualifications for Professional Right of Way Acquisition Services, which encompasses project administration, title services, appraisal services, appraisal review services, acquisition services, closing services, relocation assistance services, and property disposal services on an as-needed basis with no guaranteed minimum work.
The affidavit requires the executing party to commit to immediately notifying the City of Lakeland if the entity engages in coercion for labor or services at any point in the future, with such action resulting in the termination of all contract execution, renewal, and extension activities between the parties. Completion requires identification of the company name, authorized signature, printed name, date, title of the signatory, and notarization through either physical presence or online notarization, with the notary public providing their signature, stamp or seal, printed name, and commission expiration date. This compliance document is mandatory for all prospective contractors seeking to engage with the City of Lakeland on the right of way acquisition professional services contract.
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Other files
| File | Type | Posted |
|---|---|---|
| Professional_Right_of_Way_Acquisition_Services_(CCNA).pdf | ||
| ROW_-_Cont._Services_Contract_-_RFQ_-_09.17.26.docx | DOCX document | |
| PSM_-_Contractor_Audit_Form.pdf | ||
| Indemnification_2026_Vendor.doc | DOC document | |
| Indemnification_2026_Contractor_-_FDOT.docx | DOCX document | |
| Indemnification_2026_Consultant_-_FDOT.docx | DOCX 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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