Human_Trafficking_Affidavit_02.05.2025_(3).pdf
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- Solicitation number
- 26-0362-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 for the Fiscal Year 2027 Pavement Preservation – Package 2 contract opportunity. 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 completed with the contractor's name, the authorized representative's signature and printed name, the date of execution, and the Federal Work Authorization User Identification Number. The document requires notarization, with the notary public certifying either physical presence or online notarization of the affiant, providing identification confirmation, and affixing their notarial seal along with commission expiration date.
This affidavit is a mandatory compliance document for contractors bidding on Pinellas County contracts and serves as a prerequisite attestation regarding human trafficking and labor coercion practices. No pricing information, contract award dates, project timelines, or other substantive contract terms are contained within this affidavit form. The document functions solely as a certification mechanism to ensure contractors meet Florida's statutory requirements prohibiting the use of coercion in 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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