Human_Trafficking_Affidavit_02.05.2025.pdf
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- Solicitation number
- 25-0590-N
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This document is a Human Trafficking Affidavit for a Pinellas County contract, specifically related to a sole source agreement with Premier Magnesia for the William E. Dunn Water Reclamation Facility in Florida. The affidavit requires an authorized representative of the contractor to attest that they do not use coercion for labor or services as defined under Section 787.06 of Florida Statutes.
The affidavit provides a template for the contractor to complete, requiring signature, printed name, date, Federal Work Authorization User Identification Number, and the specific Pinellas County contract details. The document includes a notary section for official acknowledgment, with options for physical presence or online notarization. While the specific contract details are not fully populated in this document, it is part of the procurement process for a sole source agreement involving Thioguard magnesium hydroxide slurry and associated equipment for a water reclamation facility.
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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 .