Human_Trafficking_Affidavit_11.20.25.pdf
PDF 115 KB Posted
- Attached to
- Executive Search Services
- Solicitation number
- 26-0276-RFP
- Issued by
- Pinellas County, Florida
About this file
This is a Human Trafficking Affidavit form required by Pinellas County, Florida in accordance with Section 787.06(14) of the Florida Statutes. The affidavit is associated with Pinellas County's Executive Search Services contract opportunity, which seeks to establish an agreement with one or more firms to conduct nationwide executive searches for executive-level positions including Department Directors, Division Directors, Engineers, Assistant County Administrators, and other roles as deemed necessary by the County. The affidavit must be executed by an authorized representative of the contractor and notarized before a Florida notary public.
The affidavit requires the contractor to attest under penalties of perjury that the contractor does not use coercion for labor or services as defined in Florida Statutes Section 787.06. The form includes required fields for the contractor representative's signature, printed name, date, Federal Work Authorization User Identification Number, the name and contract number of the Pinellas County contract, notary acknowledgment details including the date and method of notarization (physical presence or online), notary seal, notary commission expiration date, and contractor identification information. This document serves as a compliance requirement and certification that must be submitted as part of the contracting process with Pinellas County.
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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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