Human_Trafficking_Affidavit_02.05.2025.pdf
PDF 89 KB Posted
- Attached to
- Boiler Maintenance and Repair
- Solicitation number
- 26-0107-ITB
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This is a Human Trafficking Affidavit required by Pinellas County, Florida, in accordance with Section 787.06(13) of the Florida Statutes for the Boiler Maintenance and Repair contract. The affidavit serves as a compliance document that contractors must execute to attest that they do not use coercion for labor or services as defined under Florida law. The document requires an authorized representative of the contractor to sign under penalty of perjury, providing their printed name, signature, date, and Federal Work Authorization User Identification Number. The affidavit must be notarized, with the notary public verifying the contractor's identity through either physical presence or online notarization and providing their commission expiration date.
The affidavit format includes designated fields for the contractor name, Pinellas County contract name and number, the notary's information, and identification type. This document is a standard prerequisite for state and local contracting in Florida and must be completed and submitted as part of the bidding or contract award process for the Boiler Maintenance and Repair services, which include four scheduled inspections per boiler annually—one major inspection and three minor safety inspections conducted at three-month intervals.
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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 .