Human_Trafficking_Affidavit.docx
DOCX document 15 KB Posted
- Solicitation number
- 2026-ITB-128
- 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 serves as compliance documentation under Section 787.06(14) of the Florida Statutes and must be completed and notarized by an authorized officer or representative of the contracting entity. The form requires the signatory to attest under penalty of perjury that the nongovernmental entity and its subsidiaries or affiliates do not use coercion for labor or services as defined by Florida law. The affidavit applies to the Annual Electronics Recycling Services contract, which involves the monthly pickup of used computers, laptops, and other electronic equipment from the City of Lakeland's Department of Information Technology, with provisions for additional bulk pickups as needed. The contract term is one year with four one-year renewal options available upon mutual consent.
The affidavit requires the executing party to commit to immediate notification to the City if any future use of coercion for labor or services occurs, which would prohibit contract execution, renewal, or extension. The form includes spaces for the company name, authorized signature, printed name, title, date, and notarization by a notary public with commission expiration details. No pricing, set-aside provisions, funding sources, or incumbent contractor information is specified in this affidavit document, as it functions solely as a compliance and attestation requirement prior to contract award or renewal with the City of Lakeland.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 2025-ITB-025_Bid_Tab.xlsx | XLSX spreadsheet | |
| Annual_Electronics_Recycling_Services_for_the_IT_Department.pdf | ||
| Indemnification_2026_Consultant.doc | DOC document | |
| PSM_-_Contractor_Audit_Form.pdf | ||
| Indemnification_2026_Contractor.doc | DOC document | |
| Indemnification_2026_Vendor.doc | DOC document | |
| Indemnification_2026_Consultant_-_FDOT.docx | DOCX document | |
| Indemnification_2026_Contractor_-_FDOT.docx | DOCX document |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .