Human_Trafficking_Affidavit_02.05.2025_(3).pdf
PDF 89 KB Posted
- Attached to
- STAR Center AHU -104, -161, -162 Replacement
- Solicitation number
- 26-0306-ITB-C
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This is a Human Trafficking Affidavit form required by Pinellas County, Florida for contractors bidding on the STAR Center AHU -104, -161, -162 Replacement 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 Section 787.06 of the Florida Statutes. The form must be notarized and 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 notary public information including the date of notarization and commission expiration date. Submission of this signed and notarized affidavit is a mandatory compliance requirement for all contractors pursuing this construction project, with the Step 1 Qualification Submittal deadline of March 10, 2026 at 3:00 PM.
This affidavit represents one of several mandatory certifications and compliance documents required as part of Pinellas County's procurement process for this project. Additional required affidavits include E-Verify registration confirmation, Common Carrier Attestation, and Foreign Country of Concern Affidavit, all intended to ensure contractor compliance with state and federal labor laws and security requirements. The notarized Human Trafficking Affidavit must be completed and submitted as part of the qualification package and serves to verify that the contractor's labor practices comply with Florida law regarding the prohibition of forced labor and coercive 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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