Human_Trafficking_Affidavit_.pdf

134 KB Posted

Attached to
Material Testing Services Continuing Contract
Solicitation number
25-054-RSQ
Issued by
Lee County, Fort Lauderdale City, Florida

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This is a Human Trafficking Affidavit form required by the City of Florida in compliance with Section 787.06(13), Florida Statutes, for nongovernmental entities executing, renewing, or extending contracts with the municipality. The affidavit must be completed and notarized by an authorized officer or representative of the contracting entity. The form requires attestation under penalty of perjury that the nongovernmental entity and its subsidiaries or affiliates do not use coercion for labor or services as defined in Florida Statutes, and obligates the entity to immediately notify the governmental entity if such coercion occurs at any future time, with the understanding that no contracts may be executed, renewed, or extended between the parties if violations occur.

The affidavit serves as a compliance mechanism with no pricing terms, set-asides, or funding requirements, as it is a prerequisite attestation document rather than a procurement instrument. Completion of the form, including notarization by an authorized notary public with affixed seal or stamp, is mandatory for contract eligibility. The document requires identification of the nongovernmental entity, authorized representative information, state and county of notarization, and the date of acknowledgment to establish legal validity and compliance with Florida statutory requirements.

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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 .