Human_Trafficking_Affidavit_02.05.2025_(3).pdf
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- Solicitation number
- 26-0370-RFQ-CCNAC
- Issued by
- Pinellas County, Florida
About this file
This is a Human Trafficking Affidavit form required by Pinellas County, Florida for contractors bidding on the Unmanned Aerial Services and Professional Engineering Services procurement (RFQ #26-0370-CCNAC). The affidavit requires an authorized contractor representative to attest under penalties of perjury that the firm does not use coercion for labor or services as defined in Florida Statute Section 787.06. The document must be notarized and include the contractor's name, the authorized representative's signature and printed name, the date of execution, Federal Work Authorization User Identification Number, the specific Pinellas County contract name and number, and notarization details including the notary public's information and commission expiration date. This mandatory affidavit is one of several required submittals for firms competing for the continuing as-needed contract to provide unmanned aerial vehicle services including topographic surveys, ecological assessments, infrastructure inspections, construction inspection services, shoreline and marine structure inspections, and emergency damage assessments.
The Human Trafficking Affidavit is a compliance requirement executed in accordance with Florida Statutes and must be completed by all proposers prior to contract award. Firms must ensure that an authorized representative executes the affidavit before a notary public, whether through physical presence or online notarization. The affidavit serves as a prerequisite certification alongside other mandatory compliance documents, including the Foreign Countries of Concern Affidavit, and is part of Pinellas County's procurement requirements to ensure contractors meet all state statutory obligations related to labor practices and human trafficking prevention. All affidavits must be submitted via the OpenGov Procurement platform by the April 7, 2026 deadline at 3:00 PM Eastern Time.
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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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