Human_Trafficking_Affidavit_.pdf
PDF 134 KB Posted
- Attached to
- Fort Myers Downtown Pedestrian Mall and Micromobility Feasibility Study (FDOT 451523-1-18-01)
- Solicitation number
- 25-036-RSQ
- 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 in compliance with Section 787.06(13), Florida Statutes, for nongovernmental entities executing, renewing, or extending contracts with the city. The affidavit must be completed and notarized by an authorized officer or representative of the contracting entity prior to contract execution. The form requires the signatory to attest 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 commits to immediate notification to the city if such practices occur in the future. The affidavit includes sections for company identification, authorized signature, printed name, and title of the representative, followed by notarization requirements including the notary's acknowledgment of physical presence or online notarization, commission expiration date, and official seal or stamp.
The affidavit serves as a mandatory compliance document for the Fort Myers Downtown Pedestrian Mall and Micromobility Feasibility Study contract opportunity, which involves a comprehensive two-part feasibility study investigating bicycle and pedestrian-only street and micromobility opportunities in the city's Downtown and Midtown districts. This human trafficking prevention requirement is part of the broader compliance framework that consultants must satisfy, alongside other federal and state requirements including E-Verify employment eligibility verification, anti-lobbying certifications, and DBE participation documentation. Submission of the completed and notarized affidavit is a prerequisite to contract award, with proposals due by March 6, 2025, at 2:00 pm and project completion expected within 18 months of the Notice to Proceed.
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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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