Human_Trafficking_Affidavit_.pdf
PDF 134 KB Posted
- Attached to
- South Street Sidewalk Construction from US 41/Cleveland Avenue to SR 739/Fowler Street (FDOT 438101-2-58-01)
- Solicitation number
- 25-012-ITB
- Issued by
- Lee County, Fort Lauderdale City, Florida
About this file
This is a Human Trafficking Affidavit form required by the City of Fort Myers, Florida, in compliance with Section 787.06(13) of the Florida Statutes. The affidavit must be completed and notarized by an authorized officer or representative of any nongovernmental entity executing, renewing, or extending a contract with the City. The form applies to the South Street Sidewalk Construction project from US 41/Cleveland Avenue to SR 739/Fowler Street, which involves construction of a 6-inch thick, 5-foot wide, 3,000-foot long sidewalk on the north side of South Street.
The affidavit requires the nongovernmental entity to attest under penalty of perjury that it and its subsidiaries or affiliates do not use coercion for labor or services as defined in Florida Statutes Section 787.06. The entity must commit to immediately notify the City if it engages in such coercion in the future, which would prohibit execution, renewal, or extension of any contracts between the parties. The form requires the signature and printed name of an authorized representative, their title, and notarization by a notary public who must confirm the signer's identity through physical presence or online notarization and affix their official seal or stamp. The completed affidavit serves as a prerequisite document for contract award consideration.
View the file
Other files
Show all 18
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .