Human_Trafficking_Affidavit_.pdf
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- Solicitation number
- 25-056-Quote
- Issued by
- Lee County, Fruitville CDP, Florida
About this file
This 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. The affidavit is a mandatory compliance document for a contract related to the Purchase and Installation of Mechanically Driven Influent Slide Gates for the City of Fort Myers. The affidavit requires the authorized representative of the nongovernmental entity to attest under penalty of perjury that the company and its subsidiaries do not use coercion for labor or services, as defined in the referenced Florida statute.
The affidavit includes provisions that if the nongovernmental entity ever uses coercion for labor or services in the future, they must immediately notify the governmental entity, and no further contracts may be executed, renewed, or extended between the parties. The document requires the signature of an authorized company representative, along with notarization, which can be completed through physical presence or online notarization. The form includes spaces for company details, authorized signature, printed name, title, and notary public certification, demonstrating a formal process to ensure compliance with human trafficking prevention regulations in state and local government contracting.
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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 .