Human_Trafficking_Affidavit_.pdf
PDF 134 KB Posted
- Attached to
- Meter Changeout Supplies State and local contract opportunity
- Solicitation number
- 25-046-ITB
- Issued by
- Lee County, Fort Lauderdale City, Florida
About this file
The document is a Human Trafficking Affidavit required by Section 787.06(13) of Florida Statutes, to be completed by a nongovernmental entity executing, renewing, or extending a contract with a City government. This affidavit is specifically related to a contract opportunity for meter changeout supplies by the City of Fort Myers, Florida, where the nongovernmental entity must attest that they do not use coercion for labor or services as defined in the referenced statute.
The affidavit requires the authorized representative of the nongovernmental entity to certify under penalty of perjury that their company and its subsidiaries or affiliates do not engage in coercive labor practices. The document mandates that if the entity ever uses coercion for labor or services in the future, they must immediately notify the governmental entity, which would prevent any further contract execution, renewal, or extension. The form includes spaces for company details, authorized signature, notarization, and requires the signatory to confirm personal knowledge of the statements and authorization to represent the company.
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Text version
H U M A N T R A F F I C K I N G A F F I D A V I T
In compliance with Section 787.06(13), 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 _______________ (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 non-governmental 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: Date: _____________
Printed Name:
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:______________________
| contract with the City of: |
| I am an officer or representative of: |
| Company: |
| Date: |
| Printed Name: |
| Title: |
| STATE OF: |
| COUNTY OF: |
| The foregoing instrument was acknowledged before me by means of: Off |
| physical presence or: Off |
| online notarization this 1: |
| online notarization this 2: |
| day of: |
| 20: |
| as: |
| companycorporation They: Off |
| are personally known to me or: Off |
| as identification: |
| Print Type or Stamp Name of Notary: |
| My commission expires: |
File details come from the government source that posted it. Updated .