Human_Trafficking_Affidavit.docx
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- Attached to
- Congestion Relief Alternative for SR99 State and local contract opportunity
- Solicitation number
- 2026-RFP-009
- Issued by
- Polk County, California
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 pertains to the General Employee Wage Study contract opportunity and serves as a compliance document under Section 787.06(14) of Florida Statutes. An authorized officer or representative of the contracting entity must complete and notarize the affidavit, confirming they are over 18 years of age and possess personal knowledge of the matters presented. The document requires the entity to attest that neither the nongovernmental entity nor any of its subsidiaries or affiliates utilize coercion for labor or services as defined in Florida Statutes.
The affidavit mandates that should the nongovernmental entity engage in coercion for labor or services at any point during the contract term, the entity must immediately notify the City of Lakeland, and no further contracts may be executed, renewed, or extended between the parties. The signatory must provide their company name, signature, printed name, date, and title, and the document must be acknowledged before a notary public through either physical presence or online notarization. The notary must document the date of acknowledgment, the signatory's identity verification method, and affix their official stamp or seal along with their printed name and commission expiration date. This affidavit is a mandatory compliance requirement prior to contract execution.
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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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