Human_Trafficking_Affidavit_02.05.2025.pdf
PDF 89 KB Posted
- Solicitation number
- 25-0513-N
- Issued by
- Pinellas County, Florida
About this file
The document is a Human Trafficking Affidavit for a Pinellas County contract, specifically related to a Notice of Intent to Procure Non-Competitively for a Rescue Strut System. The affidavit is a legal document that requires an authorized representative of a contractor to attest that they do not use coercion for labor or services, in compliance with section 787.06(13) of Florida Statutes. The form is designed to be completed and notarized, with spaces for the contractor's details, signature, and notary certification.
The affidavit is part of a procurement process for the Pinellas County Safety and Emergency Department to acquire technical rescue equipment. While the document itself does not provide specific details about pricing, quantities, or exact equipment specifications, it represents a critical legal compliance step in the non-competitive procurement process. The form requires the contractor to declare under penalties of perjury that they adhere to legal standards regarding labor practices, with provisions for physical or online notarization to validate the statement.
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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 |
File details come from the government source that posted it. Updated .