Human_Trafficking_Affidavit_02.05.2025_(3).pdf
PDF 89 KB Posted
- Solicitation number
- 26-0370-RFQ-CCNAC
- Issued by
- Pinellas County, Florida
About this file
This is a Human Trafficking Affidavit required by Pinellas County, Florida for contractors bidding on Unmanned Aerial Services and Professional Engineering Services (RFQ #26-0370-CCNAC). The affidavit certifies that the contractor does not use coercion for labor or services as defined in Section 787.06 of the Florida Statutes. The document must be completed and notarized by an authorized representative of the contracting firm. The affidavit includes fields for the contractor's name, the authorized representative's signature and printed name, Federal Work Authorization User Identification Number, the Pinellas County contract name and number, and the date of execution. A notary public must acknowledge the affidavit either through physical presence or online notarization, provide their commission expiration date, and affix their notarial seal. This affidavit is one of multiple mandatory certifications required for proposal submission, with a written question deadline of March 27, 2026, at 3:00 PM Eastern Time and a proposal submission deadline of April 7, 2026, at 3:00 PM Eastern Time via the OpenGov Procurement platform.
The Human Trafficking Affidavit is a compliance document with no pricing, set-aside, or funding implications. It serves as a prerequisite certification alongside a Foreign Countries of Concern Affidavit, affirming 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. All proposers must submit this notarized affidavit to be eligible for contract consideration. The contract will be awarded on a continuing as-needed basis for a five-year initial term with two optional 12-month extensions, with compensation negotiated on a per-work-assignment basis using an agreed-upon fee schedule that is fully loaded to include profit, markup, and local travel expenses within the Tampa Bay metropolitan statistical area.
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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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