Human_Trafficking_Affidavit_02.05.2025.pdf
PDF 89 KB Posted
- Attached to
- Homeless Shelter Beds Services for Adults
- Solicitation number
- 25-0197-RFP
- Issued by
- Pinellas County, Florida
About this file
The document is a Human Trafficking Affidavit for a Pinellas County contract related to Homeless Shelter Beds Services for Adults. The affidavit is a mandatory compliance document that requires a contractor to attest they do not use coercion for labor or services, in accordance with section 787.06(13) of Florida Statutes. The form requires an authorized representative of the contractor to sign and have the document notarized, confirming they have read and verified the truthfulness of the statements.
The affidavit is specifically tied to a county procurement opportunity seeking proposals from qualified organizations to provide shelter beds for homeless adults in Pinellas County, Florida. The county is looking for shelter providers demonstrating Housing First practices, including low-barrier entry, participation in Coordinated Entry System, rapid housing connection, service navigation, and financial and health stabilization support. The document provides space for recording the Federal Work Authorization User Identification Number and the specific contract details, and includes sections for physical or online notarization to validate the contractor's compliance with anti-human trafficking requirements.
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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 .