Human_Trafficking_Affidavit.docx
DOCX document 15 KB Posted
- 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 document 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 contracting entity and submitted in compliance with Section 787.06(14), Florida Statutes. The document requires the signing party 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 under Florida law. The affiant must confirm personal knowledge of the matters stated and commitment to immediately notify the City should any coercion for labor or services occur in the future, which would prevent execution, renewal, or extension of any contracts between the parties. The affidavit must be notarized by physical presence or online notarization and include the company name, authorized signature, printed name of the signatory, title, date, and notary information.
As a compliance document, the affidavit contains no pricing terms, funding information, or contract performance requirements. Rather, it serves as a mandatory pre-contractual certification that applies uniformly to all nongovernmental entities entering into agreements with the City of Lakeland. The document is straightforward in its requirements and does not specify any set-asides, incumbent designations, or special conditions. The affidavit functions as a baseline anti-trafficking certification and must be submitted alongside other required documentation such as insurance certificates, drug-free workplace certifications, debarment certifications, and e-verify compliance documentation as referenced in the related General Employee Wage Study procurement.
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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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