Human_Trafficking_Affidavit_02.05.2025.pdf

89 KB Posted

Attached to
25-0425-RFP Management, Administration & Implementation of Community Development Block Grant -Disaster Recovery (CDBG-DR) Program
Solicitation number
25-0425-RFP
Issued by
Pinellas County, Florida

About this file

Written by GovTribe AI ·

This document is a Human Trafficking Affidavit for Pinellas County, Florida, in compliance with section 787.06(13) of Florida Statutes. The form requires an authorized representative of a contractor to attest that the company does not use coercion for labor or services as defined by state law.

The affidavit requires the contractor to sign and have the document notarized, providing details such as their Federal Work Authorization User Identification Number and the specific Pinellas County contract information. The form includes spaces for a notary public to complete an acknowledgment, with options for physical presence or online notarization, and allows the notary to verify the signatory's identity through personal knowledge or presented identification.

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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 .