Human_Trafficking_Affidavit_02.05.2025.pdf
PDF 89 KB Posted
- Attached to
- SES Learning Management State and local contract opportunity
- Solicitation number
- 25-0653-RFP
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This is a Human Trafficking Affidavit form required by Pinellas County, Florida for vendors responding to RFP No. 25-0653-RFP for a cloud-based Learning Management System. The affidavit requires an authorized representative of the contractor 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 executed by a notary public and includes fields for the contractor's name, Federal Work Authorization User Identification Number, contract name and number, and the notary's commission information. This affidavit is a mandatory compliance requirement for all vendors submitting proposals for the LMS contract with a proposal due date of October 9, 2025, at 3:00 pm.
The affidavit serves as a legal certification document with no associated pricing, set-asides, or funding implications. The form can be notarized either through physical presence or online notarization and must be completed by an officer or authorized representative of the contractor's corporation. This document is one of several required legal certifications accompanying the Pinellas County procurement, along with affidavits addressing common carrier transportation and restrictions on contractors from specified foreign countries of concern. Vendors must ensure proper execution and notarization of this form as part of their proposal submission package to demonstrate compliance with Florida human trafficking statutes.
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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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