Human_Trafficking_Affidavit.docx
DOCX document 15 KB Posted
- Solicitation number
- 2026-RFQ-032
- 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 must be completed by an authorized officer or representative and attests under penalty of perjury that the entity and its subsidiaries or affiliates do not use coercion for labor or services as defined in Section 787.06, Florida Statutes. The affiant confirms personal knowledge of the statements made and commits to immediately notifying the City of Lakeland should any future violation occur, with the understanding that such violation would prevent contract execution, renewal, or extension. The document requires completion of company information, authorized signature, printed name, date, and title of the signatory.
The affidavit must be notarized with acknowledgment of the signatory's identity through physical presence or online notarization. The notary section requires documentation of the date, notary signature, notary name, and commission expiration date. This affidavit is applicable to the City of Lakeland's Construction Manager at Risk Services (CMAR) request for qualifications related to replacement of control structure gates at Se7en Wetlands, and all interested contractors must submit this completed and notarized affidavit in compliance with Florida Statutes as a condition of contract consideration.
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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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