ITB202608_CDBG_Infrastructure_Improvement_Project__Exhibit_T.pdf
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- Attached to
- Infrastructure Improvement Project
- Solicitation number
- ITB-2026-08 CDBG
- Issued by
- Santa Rosa County, Florida
About this file
This is an Anti-Human Trafficking Compliance Affidavit executed in connection with Contract No. CDBG-CON-01 between a nongovernmental entity contractor and the City of Milton, Florida for a CDBG Infrastructure Improvement Project. The affidavit serves as a mandatory compliance document required under Florida Statute 787.06(14) and must be executed by an authorized officer or representative of the contracting entity. The contractor attests that it does not use coercion for labor or services as defined under Florida law and acknowledges that this representation is continuing in nature, requiring prompt written notification to the City if any circumstances change that would render the affidavit inaccurate. The contractor further agrees to recertify the affidavit upon each renewal or extension of the contract.
The affidavit establishes that violation of Florida Statute 787.06 or submission of a false affidavit constitutes grounds for termination for cause and subjects the contractor to civil and criminal liability as set forth in the contract and applicable law. The document requires notarization before a notary public and must be signed by an authorized representative of the contractor, with all required fields completed including the contractor name, authorized signature, printed name, title, date, and notary information including commission number and expiration date.
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Text version
EXHIBIT T – ANTI-HUMAN TRAFFICIKING COMPLIANCE
AFFIDAVIT
CDBG Infrastructure Improvement Project
Authority: § 787.06, F.S.
Contract No. CDBG-CON-01
In compliance with § 787.06(14), Florida Statutes, this Affidavit is executed by an officer or authorized representative of _____________________________________ (the
"Nongovernmental Entity") in connection with its execution, renewal, or extension of a contract with the City of Milton, Florida (the "Governmental Entity").
The undersigned, being first duly sworn, attests as follows:
1. Authority. I am an officer or authorized representative of the Nongovernmental Entity and am authorized to execute this Affidavit on its behalf.
2. No Coercion for Labor or Services. The Nongovernmental Entity does not use coercion for labor or services, as defined in § 787.06, Florida Statutes.
3. Continuing Obligation. This is a continuing representation. The Nongovernmental
Entity will promptly notify the City in writing of any change that renders any statement above inaccurate and will recertify upon each renewal or extension of the Contract.
Under penalties of perjury, I declare that I have read the foregoing and that the facts stated herein are true and correct.
The Nongovernmental Entity understands that a violation of § 787.06, Florida Statutes, or submission of a false affidavit, is grounds for termination for cause and is subject to the consequences set forth in the Contract and applicable law, including civil and criminal liability.
Contractor: ___________________________________________
Authorized Signature: ______________________________________________
Printed Name: _____________________________________________________
Title: _____________________________________________
Date: ____________________________________________
STATE OF FLORIDA | COUNTY OF __________________
Sworn to (or affirmed) and subscribed before me by means of ☐ physical presence or ☐ online notarization this ____ day of ________________, 20, by
_______________________________________, who is ☐ personally known to me OR ☐ produced _______________________________ as identification.
Signature of Notary: ___________________________
Print Name: __________________________________
Commission No.: _______________________________
My Commission Expires: ________________________
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