Human_Trafficking_Affidavit.docx
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- Solicitation number
- 2026-ITB-111
- 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 nongovernmental entities executing, renewing, or extending contracts with the municipality. The affidavit applies to the Glendale Street Trail project from New Jersey Road to Lakeland Highlands Road, which involves construction of a 10-foot wide shared-use path including clearing and grubbing, earthwork and grading, roadway reconstruction, sidewalk and driveway construction, and drainage improvements. The contractor must be a Florida Department of Transportation pre-qualified state registered contractor in workgroups 07 (drainage), 10 (flexible paving), 28 (pavement marking), 38 (roadway signing), and 40 (sidewalk and other work classes). All work shall comply with project plans and specifications prepared by the City of Lakeland Public Works Engineering Department (FPID: 453404-1-58-01 and City Project No. 008202) and all applicable codes, requirements, and regulations.
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 Section 787.06, and that any future violation would result in immediate notification to the City and termination of contract execution, renewal, or extension. The affidavit must be notarized by physical presence or online notarization and include the company name, authorized signature, printed name, date, title, and notary public acknowledgment with commission expiration date. The project utilizes federal and state funding under a Local Agency Agreement, making compliance with all referenced funding requirements mandatory.
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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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