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 form required by the City of Lakeland, Florida, in compliance with Section 787.06(14), Florida Statutes, for nongovernmental entities executing, renewing, or extending contracts with the municipality. The affidavit 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 also obligates the entity to immediately notify the City of Lakeland if coercion for labor or services occurs at any point during the contract term, with the understanding that failure to comply may result in suspension or termination of contract execution, renewal, or extension. The document includes standard notarization provisions allowing for either physical presence or online notarization and requires the notary public to affix their official stamp or seal and indicate commission expiration date.
This document serves as a compliance certification rather than a procurement document and contains no pricing information, set-asides, incumbent vendor details, funding requirements, or contract value information. The affidavit is a prerequisite submission for all nongovernmental entities seeking to do business with the City of Lakeland and reflects the municipality's commitment to combating human trafficking and labor exploitation in its vendor relationships. The form is straightforward in its requirements and does not establish specific performance metrics, deliverables, timelines, or project scopes beyond the attestation of compliance with Florida's anti-trafficking statutes.
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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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