[AA]_Human_Trafficking_Affidavit_02.05.2025.pdf

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Attached to
US&R Rescue Strut System Paratech Equipment - Tampa Bay Area Cooperative
Solicitation number
25-0676-ITB
Issued by
Pinellas County, Clewiston City, Florida

About this file

This is a Human Trafficking Affidavit form required by Pinellas County, Florida in accordance with Section 787.06(13) of the Florida Statutes for the US&R Rescue Strut System Paratech Equipment procurement. The affidavit must be completed and notarized by an authorized representative of the bidding contractor, certifying that the contractor does not use coercion for labor or services as defined in Florida law. The document requires the contractor's authorized signatory to declare under penalties of perjury that the attestation is true, along with the contractor's Federal Work Authorization User Identification Number and the specific Pinellas County contract name and number. The form must be notarized either through physical presence or online notarization, with the notary public providing their commission expiration date and identifying information. The affidavit serves as a mandatory compliance requirement for bid submission, ensuring that all contractors meet Florida's human trafficking prevention standards prior to contract award.

The Human Trafficking Affidavit contains no pricing terms, set-aside provisions, funding information, or other financial considerations, as it functions solely as a statutory compliance and certification document. Submission of this completed and notarized affidavit is a prerequisite for bid consideration in the Paratech equipment procurement, which has a proposal submission deadline of June 19, 2025 at 3:00 pm. The affidavit must be submitted electronically via OpenGov along with other required bid documentation and represents a standard requirement across all Pinellas County and Tampa Bay Area Cooperative solicitations.

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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 .