[AA]_Human_Trafficking_Affidavit_02.05.2025.pdf
PDF 89 KB Posted
- Solicitation number
- 25-0676-ITB
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
The document is a Human Trafficking Affidavit form for Pinellas County, Florida, specifically related to a US&R Rescue Strut System Paratech Equipment procurement for the Tampa Bay Area Cooperative. The affidavit requires an authorized contractor representative to attest that they do not use coercion for labor or services, in compliance with Florida Statute 787.06(13). This document appears to be a mandatory compliance form for contractors bidding on an Urban Search and Rescue (US&R) equipment contract involving specialized rescue struts designed for structural collapse scenarios and standardized by FEMA.
The affidavit requires notarization and includes fields for the contractor's Federal Work Authorization User Identification Number, contract details, and notary verification. While the document itself does not provide specific pricing or funding information, the related contract opportunity description indicates that the procurement is for precise Paratech strut system items, with bids to be carefully reviewed by the Department and Technical Rescue Team (TRT). The equipment is critical for emergency response operations, and the procurement process emphasizes compatibility with existing county inventory and strict adherence to FEMA standards for urban search and rescue equipment.
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Text version
HUMAN TRAFFICKING AFFIDAVIT
In accordance with section 787.06 (13), Florida Statutes, the undersigned, on behalf of ____________________________ (the “Contractor”), hereby attests that the Contractor does not use coercion for labor or services as defined in Section 787.06, Florida Statutes.
The undersigned must be an authorized representative of the Contractor who can execute this affidavit on the Contractor’s behalf.
Under penalties of perjury, I______________________, declare that I have read the foregoing affidavit and that the facts stated in it are true.
Signature: ______________________________ Print Name: ______________________________
Date: ______________________________ Federal Work Authorization User Identification No.: _____________________________ Name of Pinellas County Contract and Contract No.: ____________________________
STATE OF FLORIDA COUNTY OF ________________
The foregoing instrument was acknowledged before me by means of 1) physical presence __ or
2) online notarization___, this __________________________ (date) by ____________________________ of _____________________________________, a __________________________________ corporation, on behalf of the corporation.
He/she is personally known to me or has produced __________________________________ as identification.
[Notary Seal]
Notary Public: _________________________________________ Name typed, printed, or stamped: _________________________________________
My Commission Expires: _________________________________________
| Print Name: |
| Federal Work Authorization User Identification No: |
| Name of Pinellas County Contract and Contract No: |
| Notary Public: |
| Name typed printed or stamped: |
| My Commission Expires: |
| Contractor Name: |
| Contractor Name 1: |
| Pinellas County: |
| Date: |
| Check Box1: Yes |
| Notary Name: |
| 1: |
| 2: |
| Type of Identification: |
| Check Box2: Off |
File details come from the government source that posted it. Updated .