Human_Trafficking_Affidavit_02.05.2025.pdf
PDF 89 KB Posted
- Solicitation number
- 25-0318-RFP
- Issued by
- Pinellas County, Florida
About this file
This document is a Human Trafficking Affidavit form for Pinellas County, Florida, designed to comply with section 787.06(13) of the Florida Statutes. The form requires an authorized representative of a contractor to attest that they do not use coercion for labor or services as defined in the referenced statute.
The affidavit includes spaces for the contractor's representative to provide their signature, printed name, date, and Federal Work Authorization User Identification Number. The document also includes a notary section for official acknowledgment, with options for physical presence or online notarization. The form serves as a legal declaration that the contractor understands and complies with Florida's human trafficking prevention regulations, and must be executed by an authorized representative of the contracting entity.
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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 |
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