Human_Trafficking_Affidavit_02.05.2025_(3).pdf
PDF 89 KB Posted
- Attached to
- STAR Center AHU -104, -161, -162 Replacement
- Solicitation number
- 26-0306-ITB-C
- 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, related to the STAR Center AHU -104, -161, -162 Replacement project. The affidavit serves as a certification document that must be completed and notarized by an authorized representative of any contractor bidding on or awarded a Pinellas County contract. The form requires the contractor to attest under penalties of perjury that the company does not use coercion for labor or services as defined in Florida Statutes Section 787.06, thereby confirming compliance with state human trafficking prevention requirements.
The affidavit requires completion of contractor identification information, including the contractor name, Federal Work Authorization User Identification Number, and the specific Pinellas County contract name and number. The document must be signed by an authorized representative of the contractor and subsequently notarized by a Florida notary public, who must document the date of acknowledgment, the method of notarization (physical presence or online), and the type of identification presented. This certification is a mandatory compliance requirement for all contractors engaging with Pinellas County on state and local contract opportunities in Florida.
View the file
Other files
Show all 21
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .