Human_Trafficking_Affidavit.docx
DOCX document 15 KB Posted
- Solicitation number
- 2026-RFP-129
- 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 applies to the Annual Water Treatment Plant High Service Pump Maintenance Contractor opportunity, which involves providing inspection, maintenance, repair, and testing services for vertical turbine and split case horizontal high service pumps at the T.B. Williams and C. Wayne Combee Water Treatment Plants, as well as the Highlands, Southwest, and Southeast Booster Stations. The selected contractor must demonstrate expertise in vertical turbine pump systems and Peerless & Flowserve equipment, with the capability to deliver preventative maintenance services to ensure reliable operation and minimize downtime of critical water production and distribution equipment. The contract term is one year with four optional one-year renewals available upon mutual consent.
Under Florida Statutes Section 787.06(14), the contracting entity must certify that it and any subsidiaries or affiliates do not use coercion for labor or services. An authorized officer or representative must complete and sign the affidavit under penalty of perjury, with notarization required. The affidavit commits the entity to immediately notify the City of Lakeland if coercion for labor or services occurs at any future time, with the understanding that such violation would prevent contract execution, renewal, or extension. This compliance requirement applies to all nongovernmental entities seeking to do business with the City of Lakeland on this and other contracts.
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Other files
| File | Type | Posted |
|---|---|---|
| Annual_Water_Treatment_Plant_High_Service_Pump_Maintenance_Contractor_(Addendum_#1_Revision).pdf | ||
| Annual_Water_Treatment_Plant_High_Service_Pump_Maintenance_Contractor.pdf | ||
| Dimensions_for_Williams_Plant.pdf | ||
| List_of_pumps.pdf | ||
| Dimensions_for_Combee_Plant.pdf | ||
| PSM_-_Contractor_Audit_Form.pdf | ||
| Indemnification_2026_Contractor.doc | DOC document | |
| Indemnification_2026_Contractor_-_FDOT.docx | DOCX document | |
| Indemnification_2026_Consultant.doc | DOC document | |
| Indemnification_2026_Vendor.doc | DOC document | |
| Indemnification_2026_Consultant_-_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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