Human_Trafficking_Affidavit_02.05.2025.pdf
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- Solicitation number
- 25-0779-ITB
- Issued by
- Pinellas County, Florida
About this file
This document is a Human Trafficking Affidavit for a Pinellas County contract related to Overhead/Security Doors Maintenance, Repair and Replacement Services. The affidavit 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, Federal Work Authorization User Identification Number, and specific contract information.
The affidavit is a standard compliance document that ensures contractors participating in Pinellas County contracts affirm their commitment to ethical labor practices. By signing under penalties of perjury, the contractor declares that they have read and understand the document and that the statements made are true. The form includes provisions for both physical presence and online notarization, providing flexibility in the execution of the document. While the specific contract details are not elaborated in this document, it is associated with a county-wide contract for overhead and security door maintenance, repair, and replacement services across all Pinellas County departments.
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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 .