Human_Trafficking_Affidavit_02.05.2025_(3).pdf
PDF 89 KB Posted
- Attached to
- Reconstruct Airport Perimeter Fence Phase 2-PIE
- Solicitation number
- 26-0618-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 compliance with Section 787.06(13) of the Florida Statutes. The affidavit serves as a mandatory certification document for contractors bidding on or executing contracts with Pinellas County, including the St. Pete-Clearwater International Airport's Reconstruct Airport Perimeter Fence Phase 2 project. The form requires an authorized representative of the contracting entity to attest under penalties of perjury that the contractor does not use coercion for labor or services as defined in Florida Statutes Section 787.06. The affidavit must be notarized and include the contractor's name, the relevant Pinellas County contract number, the notary's information and commission expiration date, and the Federal Work Authorization User Identification Number.
The affidavit contains no pricing terms, set-asides, funding information, or contract-specific conditions. Rather, it functions as a compliance certification that contractors must complete and submit as part of the contracting process. The document requires physical or online notarization and serves as a legal attestation regarding the contractor's labor practices and adherence to anti-human trafficking statutes. This affidavit is a prerequisite document for contract award and must be executed by an individual with authority to bind the contracting entity.
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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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