Human_Trafficking_Affidavit_.pdf

134 KB Posted

Attached to
Brick Paver Maintenance and New Installation
Solicitation number
25-016-RFP
Issued by
Lee County, Fruitville CDP, Florida

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The document is a Human Trafficking Affidavit required by Section 787.06(13) of Florida Statutes, intended for a nongovernmental entity executing, renewing, or extending a contract with a city government. The affidavit is specifically associated with the City of Fort Myers' brick paver maintenance and new installation contract opportunity, and requires an authorized representative of the bidding company to attest that the organization does not use coercion for labor or services as defined under Florida law.

The affidavit mandates that the nongovernmental entity affirm, under penalty of perjury, that neither the company nor its subsidiaries or affiliates engage in labor coercion. The document requires the company representative to certify their understanding that if coercive labor practices are discovered at any point, they must immediately notify the governmental entity, which will result in contract termination. The form includes spaces for company details, an authorized signature, notarization, and includes provisions for both physical and online notarization methods to validate the affidavit's authenticity.

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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 .