Human_Trafficking_Affidavit_02.05.2025.pdf
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- Solicitation number
- 25-0318-RFP
- Issued by
- Pinellas County, Florida
About this file
The document is a Human Trafficking Affidavit for a Pinellas County contract opportunity related to a Deferred Compensation Plan Consultant RFP (Request for Proposal). The affidavit is designed to ensure compliance with Section 787.06(13) of Florida Statutes, requiring contractors to attest that they do not use coercion for labor or services. The form is to be completed by an authorized representative of the contractor, who must declare under penalties of perjury that the statements are true, and the document must be notarized.
This affidavit is specifically associated with the 25-0318-RFP for financial investment consultant services for Pinellas County's 457(b) Deferred Compensation and Health Savings Account investment plans. The contract has an initial term upon execution, with a duration of five years and the option to extend for two additional twelve-month renewal terms, subject to mutual agreement. The selected consultant will serve as an independent reviewer of the plan's recordkeeping, administration, and investments, providing oversight and guidance for the county's investment programs.
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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 .