Human_Trafficking_Affidavit_.pdf
PDF 134 KB Posted
- Solicitation number
- 25-057-ITB
- Issued by
- Lee County, Fort Lauderdale City, Florida
About this file
This document is a Human Trafficking Affidavit required by Section 787.06(13) of Florida Statutes for nongovernmental entities executing, renewing, or extending a contract with a city government. The affidavit is a legal attestation that requires an authorized officer or representative of a company to affirm under penalty of perjury that their organization does not use coercion for labor or services as defined in the referenced statute.
The affidavit includes five key provisions: 1) the signatory must be over 18 and have personal knowledge of the matters, 2) they must be an authorized representative of the nongovernmental entity, 3) the entity and its subsidiaries/affiliates do not use coercion for labor or services, 4) the entity agrees to immediately notify the governmental entity if coercion is ever used in the future, and 5) the signatory confirms the facts are true. The document also includes spaces for notarization, including options for physical or online notarization, and requires the signatory's company name, signature, printed name, and title.
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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: |
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