Human_Trafficking_Affidavit.pdf
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- Solicitation number
- ITB-26-18-CW
- Issued by
- Volusia County, Florida
About this file
This is a Human Trafficking Affidavit required by Section 787.06 of the Florida Statutes for the City of Port Orange's Mitigation Reconstruction of a Flood Prone Home Project in Volusia County, Florida. The affidavit is a sworn statement that must be completed by an authorized officer or representative of any non-governmental entity submitting a bid for the project. The form requires the affiant to certify under penalties of perjury that the entity does not use coercion as defined in Florida law for labor or services. The document must be notarized and includes spaces for the affiant's name, title, entity name, date of execution, notary seal, and identification of the notary public completing the verification.
This affidavit serves as a compliance and integrity requirement for bidders on the City of Port Orange's home rebuild project, which involves the installation of a new elevated manufactured home in a manufactured home park community. Bidders must complete and submit this sworn statement to certify their organization's commitment to lawful labor practices and compliance with Florida's human trafficking prohibitions. The document requires notarization to authenticate the affiant's identity and the truthfulness of the statements made on behalf of the bidding entity.
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Text version
HUMAN TRAFFICKING AFFIDAVIT
(SECTION 787.06, FLORIDA STATUTES)
STATE OF FLORIDA §
COUNTY OF VOLUSIA §
The undersigned (“Affiant”), on behalf of the entity listed below (“Entity”), after being duly sworn, hereby attests as follows:
1. My name is ______________________________. I am over the age of Twenty-one years old. I am the
_______________________ of___________________________________, a non- governmental entity which does (Title) (Business Name) business in the State of Florida, hereinafter called the “Entity.”
2. I have personal knowledge of each and every statement of fact contained herein, and each and every statement of fact is true and correct.
3. Entity does not use coercion, as defined in Section 787.06, Florida Statutes, for labor or services.
4. The undersigned is an officer or representative of the entity and is authorized to execute this affidavit on behalf of the Entity.
5. Under penalties of perjury, I declare that I have read the foregoing Human Trafficking Affidavit and that the facts stated herein are true.
Further Affiant sayeth not.
Date: _______________________, 20____ Signed: ___________________________________________ Print Name: ______________________________________ Title: ________________________________________________________
SUBSCRIBED AND SWORN before me by means of [_XX_] physical presence or [__] online notarization on the _____ day of _____________, 20___ by ___________________________ as _________________ on behalf of _______________________________________ who is personally known to me or who has produced ______________________________ as identification.
(Notary Seal) _____________________________________ Notary Public, State of Florida Printed name, commission and expiration of commission term
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