Human_Trafficking_Affidavit_11.20.25.pdf
PDF 115 KB Posted
- Attached to
- HVAC-Systems and Related Services
- Solicitation number
- 26-0009-RFP
- Issued by
- Pinellas County, Florida
About this file
This is a Human Trafficking Affidavit required by Pinellas County, Florida, in accordance with Section 787.06(14) of the Florida Statutes. The affidavit pertains to the HVAC Systems and Related Services contract, specifically a comprehensive Chiller Preventive Maintenance and Condition Assessment program. The contractor must attest under penalties of perjury that it does not use coercion for labor or services as defined in Florida law. The affidavit requires completion and signature by an authorized representative of the contractor, notarization by a Florida notary public, and submission to Pinellas County with the contractor's Federal Work Authorization User Identification Number and the specific contract name and number.
The affidavit serves as a compliance requirement for all contractors engaging with Pinellas County on state and local contracts. No pricing, funding, or performance metrics are addressed in this document, as it functions solely as a mandatory certification of legal compliance regarding human trafficking and labor coercion standards established by Florida statute. Contractors must ensure proper execution and notarization before submitting this form as part of their contract documentation.
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Text version
HUMAN TRAFFICKING AFFIDAVIT
In accordance with section 787.06 (14), 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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