Human_Trafficking_Affidavit_02.05.2025_(3).pdf
PDF 89 KB Posted
- Attached to
- FY2026 Airfield Pavement Rehabilitation
- Solicitation number
- 26-0722-ITB-C
- Issued by
- Pinellas County, 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, for contractors bidding on the FY2026 Airfield Pavement Rehabilitation project. The affidavit requires an authorized representative of the contractor to attest under penalties of perjury that the contractor does not use coercion for labor or services as defined in Florida law. The form must be notarized and include the contractor's name, the authorized representative's signature and printed name, the date of execution, the Federal Work Authorization User Identification Number, and the name and number of the Pinellas County contract. The notary section requires acknowledgment of the affidavit through either physical presence or online notarization, identification of the signatory, and the notary's seal, name, and commission expiration date.
This affidavit is a mandatory compliance document rather than a pricing or technical submission document. It serves as a prerequisite requirement for contract award and applies to all contractors regardless of contract value or type. No pricing information, set-asides, or incumbent contractor details are contained in this document. The affidavit's primary function is to ensure that contractors comply with Florida's human trafficking and labor coercion statutes as a condition of doing business with Pinellas County.
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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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