Human_Trafficking_Affidavit_02.05.2025_(3).pdf
PDF 89 KB Posted
- Solicitation number
- 26-0394-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
Human Trafficking Affidavit for Pinellas County HVAC Renovation Project
This is a mandatory Human Trafficking Affidavit form required by Pinellas County, Florida for the Solid Waste Administration Building HVAC Renovation project (ITB-C #26-0394-ITB-C), executed in compliance with Florida Statute Section 787.06(13). The affidavit requires an authorized representative of the contractor to attest under penalty of perjury that the contractor does not use coercion for labor or services as defined in Florida law. The form must be notarized and includes fields for the contractor's name, Federal Work Authorization User Identification Number, the Pinellas County contract name and number, the authorized representative's signature and printed name with date, and complete notarization information including the notary public's seal, commission expiration date, and identification verification method. The affidavit is a mandatory compliance requirement for all bidders on this construction project and must be submitted as part of the sealed bid proposal.
This document serves as a critical pre-award compliance verification tool that all contractors and subcontractors must complete and submit with their bid responses. The notarized Human Trafficking Affidavit is one of several mandatory compliance submissions required for this project, alongside E-Verify affidavits, Foreign Country of Concern affidavits, and Common Carrier attestations. The execution of this affidavit confirms the contractor's commitment to complying with federal and state labor trafficking laws and establishes contractual accountability for maintaining lawful employment practices throughout project performance.
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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 |
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