Human_Trafficking_Affidavit_.pdf

134 KB Posted

Attached to
Actuarial Services for City Pensions
Solicitation number
25-038-RFP
Issued by
Lee County, Fort Lauderdale City, Florida

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The document is a Human Trafficking Affidavit required by Section 787.06(13), Florida Statutes, to be completed by a nongovernmental entity executing, renewing, or extending a contract with a city government. The affidavit is specifically related to an Actuarial Services for City Pensions contract opportunity with the City of Fort Myers, Florida, which seeks qualified actuarial firms specialized in defined benefit pension plans to provide guidance, valuations, and analysis for addressing current pension plans, identifying opportunities, and mitigating risks.

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 Florida Statutes. The document mandates that if coercion is ever used, the entity must immediately notify the governmental entity, which would prevent any contract execution, renewal, or extension. The affidavit must be signed by an authorized representative, dated, and notarized, with provisions for both physical presence and online notarization.

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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 .