Human_Trafficking_Affidavit_02.05.2025.pdf
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- Solicitation number
- 25-0718-ITB
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This is a Human Trafficking Affidavit form required by Pinellas County, Florida for the Lealman Residential Waste Collection and Disposal Services contract opportunity. The affidavit requires an authorized contractor representative to attest under penalties of perjury that the contractor does not use coercion for labor or services as defined in Section 787.06 of the Florida Statutes. The form must be notarized and includes fields for the contractor's name, the authorized representative's signature and printed name, the Federal Work Authorization User Identification Number, the Pinellas County contract name and number, and the date of execution. The notary section requires acknowledgment of the affidavit through either physical presence or online notarization, along with the notary's commission expiration date and identification of the signatory.
This affidavit is a mandatory compliance document for bidders responding to Pinellas County's solicitation for waste collection and disposal services covering approximately 7,900 residential units in the Lealman Solid Waste Collection and Disposal District. The Invitation to Bid was issued on November 13, 2025, with proposals due by January 8, 2026, and the initial contract term beginning January 1, 2027 for 60 months with five optional 12-month extensions. The Human Trafficking Affidavit, along with other required documents including a Foreign Countries of Concern Affidavit and Common Carrier Attestation, serves as part of the county's comprehensive compliance screening to ensure that only responsible contractors participate in the procurement process.
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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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