Human_Trafficking_Affidavit_11.20.25.pdf
PDF 115 KB Posted
- Attached to
- Artificial Reef - Tire Removal Project State and local contract opportunity
- Solicitation number
- 26-0349-RFP
- Issued by
- Pinellas County, Florida
About this file
This is a Human Trafficking Affidavit document required by Pinellas County, Florida, in accordance with Section 787.06(14) of the Florida Statutes. The affidavit pertains to the Artificial Reef - Tire Removal Project, which involves the removal of approximately 3,300 tires from five artificial reef areas off the Pinellas County coast, including the Clearwater Artificial Reef Area (320 acres), Rube Allyn Reef Area (220 acres), St. Pete Beach Artificial Reef Area (60 acres), Treasure Island Artificial Reef Area (85 acres), and Madeira Beach Artificial Reef Area (85 acres). Recovered tires and marine debris are to be transported to the Artificial Reef Program Staging area at Pinellas County Sand Key Park, located at 1060 Gulf Boulevard, Clearwater, Florida. The affidavit must be executed by an authorized representative of the contractor and notarized before a Florida notary public.
The affidavit serves as a compliance requirement whereby the contractor attests under penalties of perjury that it does not use coercion for labor or services as defined in Florida law. The document requires the contractor's authorized representative to provide their signature, printed name, date, and Federal Work Authorization User Identification Number. Additionally, the affidavit must identify the Pinellas County contract name and contract number, and it requires notarization with the notary public providing their commission expiration date. This affidavit is a mandatory prerequisite for contract award and performance on county projects.
View the file
Other files for this state and local contract opportunity
Show all 41
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 |
File details come from the government source that posted it. Updated .