Human_Trafficking_Affidavit_02.05.2025.pdf
PDF 89 KB Posted
- Attached to
- Marketing Representation-Mid Atlantic Region
- Solicitation number
- 25-0754-RFQ
- Issued by
- Pinellas County, Florida
About this file
This document is a Human Trafficking Affidavit form for Pinellas County, Florida, which requires contractors to attest that they do not use coercion for labor or services as defined under Florida Statute 787.06(13). The form is designed to be completed by an authorized representative of a contractor, who must declare under penalties of perjury that they have read the affidavit and that the facts stated are true.
The affidavit requires the contractor to provide details such as their Federal Work Authorization User Identification Number and the specific Pinellas County contract number. The document includes a notary section for official acknowledgment, with options for physical presence or online notarization. The form serves as a legal declaration and verification that the contractor adheres to Florida's statutes prohibiting human trafficking and labor coercion, and must be signed and notarized before submission with a contract proposal or agreement.
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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 .