Human_Trafficking_Affidavit_02.05.2025_(3).pdf
PDF 89 KB Posted
- Solicitation number
- 26-0394-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. The affidavit applies to the Solid Waste Administration Building HVAC Renovation project and must be executed by an authorized representative of the contracting firm. The document requires the contractor to attest under penalties of perjury that it does not use coercion for labor or services as defined in Florida law. The affidavit must include the contractor's name, the authorized representative's signature and printed name, execution date, Federal Work Authorization User Identification Number, and the name and number of the Pinellas County contract. The form requires notarization before a Florida notary public, who must certify the method of acknowledgment (physical presence or online notarization), the date, the contractor representative's name and entity type, identification verification, and commission expiration date.
This affidavit serves as a compliance requirement for contractors bidding on Pinellas County projects and does not contain pricing information, contract terms, or performance specifications. Submission of the completed and notarized affidavit is mandatory for contract award consideration. The document template includes fields for the contractor, notary public, and Pinellas County to complete relevant information, including checkboxes for identification type verification and notarization method. This form must be executed prior to contract execution to demonstrate the contractor's commitment to lawful labor practices and compliance with Florida human trafficking statutes.
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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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