Human_Trafficking_Affidavit_02.05.2025_(3).pdf
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- Solicitation number
- 26-0364-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. The affidavit pertains to the Fiscal Year 2027 Pavement Preservation - Package 4 contract opportunity, which involves milling and resurfacing services across five paving locations totaling approximately 34.81 lane miles of roadway within Pinellas County. The package consists of one arterial project and four local neighborhood projects designed to promote traffic safety and efficiency throughout the county's roadway network. Contractors must complete and execute the affidavit prior to contract award, with an authorized representative signing under penalties of perjury to attest that the contractor does not use coercion for labor or services as defined in Florida Statutes.
The affidavit requires the contractor's authorized representative to provide personal identification information, including their Federal Work Authorization User Identification Number, along with the contractor's legal name and the specific Pinellas County contract number. The form must be notarized before a notary public, with the notary completing acknowledgment of the signatory's identity through either physical presence or online notarization. This compliance document serves as a prerequisite certification that the contractor maintains ethical labor practices and does not engage in human trafficking or labor coercion, establishing a baseline requirement for participation in Pinellas County public works contracts.
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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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