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 contractor does not use coercion for labor or services as defined in Section 787.06 of the Florida Statutes. The form must be notarized and includes fields for the contractor's name, the authorized representative's signature and printed name, date of execution, Federal Work Authorization User Identification Number, the notary's information and commission expiration date, and the specific Pinellas County contract name and number. The document serves as a mandatory compliance requirement for all proposers submitting qualifications by the April 7, 2026 deadline at 3:00 PM Eastern Time.
All proposers must complete and submit the Human Trafficking Affidavit as part of their proposal package via the OpenGov Procurement platform. In addition to this affidavit, contractors must comply with a Foreign Countries of Concern Affidavit certifying that the firm and its controlling interests are not owned or controlled by specified foreign governments including China, Russia, Iran, North Korea, Cuba, Venezuela, or Syria. These mandatory affidavits are compliance documents with no direct financial or scoring impact but represent non-negotiable submission requirements. Failure to provide properly executed and notarized affidavits may result in proposal rejection. The affidavit requirement applies uniformly to all contractors regardless of firm size, location, or minority business status.
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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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