Human_Trafficking_Affidavit_02.05.2025.pdf
PDF 89 KB Posted
- Solicitation number
- 25-0763-RFP
- Issued by
- Pinellas County, Florida
About this file
This document is a Human Trafficking Affidavit for a Pinellas County contract related to on-call professional services for post-storm recovery services. The affidavit requires an authorized representative of a contractor to attest that they do not use coercion for labor or services, in accordance with Section 787.06(13) of Florida Statutes. The document provides a template for a contractor to declare under penalties of perjury that they comply with human trafficking regulations, and includes spaces for signature, date, federal work authorization identification, and notarization.
The affidavit is part of a broader solicitation by Pinellas County seeking proposals from vendors to provide professional services supporting recovery efforts after natural disasters. These services include Building Code Administration, Floodplain Management Ordinance Administration & Enforcement, Code Enforcement, and Communications Support. The county reserves the right to select one or multiple vendors based on their experience and qualifications. The human trafficking affidavit serves as a mandatory compliance document to ensure ethical labor practices among potential contractors bidding on this county-wide professional services contract.
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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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