Human_Trafficking_Affidavit_02.05.2025_(3).pdf
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- Solicitation number
- 26-0363-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This is a Human Trafficking Affidavit required by Pinellas County, Florida in accordance with Section 787.06(13) of the Florida Statutes, related to the Fiscal Year 2027 Pavement Preservation Package 3 contract opportunity. The affidavit 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 document must be notarized and includes spaces for the contractor's name, the authorized representative's signature and printed name, the date of execution, the Federal Work Authorization User Identification Number, the Pinellas County contract name and contract number, and notary information including the notary's seal and commission expiration date.
This affidavit serves as a compliance document that contractors must execute and submit as part of their bid or contract award process with Pinellas County. The form requires notarization either through physical presence or online notarization and must be completed by an individual authorized to execute the affidavit on behalf of the contracting entity. Contractors must provide their Federal Work Authorization User Identification Number and identify the specific Pinellas County contract to which the affidavit applies. The affidavit is a mandatory requirement designed to ensure that contractors comply with Florida's anti-human trafficking statutes and do not engage in exploitative labor practices.
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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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