Human_Trafficking_Affidavit_.pdf
PDF 134 KB Posted
- Attached to
- Fleishman Park Improvements State and local contract opportunity
- Solicitation number
- 25-020-ITB
- Issued by
- Lee County, Fort Lauderdale City, Florida
About this file
The document is a Human Trafficking Affidavit form required by Section 787.06(13) of Florida Statutes, applicable to nongovernmental entities executing, renewing, or extending a contract with a city government. The affidavit must be completed by an authorized officer or representative, affirming that the entity and its subsidiaries do not use coercion for labor or services as defined in the referenced statute. If such coercion occurs in the future, the nongovernmental entity must immediately notify the governmental entity, and no further contracts may be executed, renewed, or extended.
The form requires the signing representative to attest under penalty of perjury that they are over 18, have personal knowledge of the matters stated, and are authorized to provide the affidavit on behalf of their organization. The document includes spaces for company information, authorized signature, date, printed name, and title, and requires notarization with options for physical presence or online notarization. This affidavit is specifically linked to the Fleishman Park Improvements project for the City of Fort Myers, which involves demolishing and replacing roof structures over bleachers and dugouts.
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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 .