Human_Trafficking_Affidavit_11.20.25.pdf
PDF 115 KB Posted
- Solicitation number
- 26-0234-RFP
- Issued by
- Pinellas County, Clewiston City, 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, for use in conjunction with the Janitorial Services for Construction and Property Management Facilities RFP (RFP 26-0234-RFP). The affidavit requires an authorized contractor representative to attest under penalties of perjury that the contractor does not use coercion for labor or services as defined in Florida law. The form must be notarized before contract award and includes fields for the contractor's name, Federal Work Authorization User Identification Number, Pinellas County contract name and number, the signatory's printed name and signature, the date of execution, and notary acknowledgment details including the notary's seal, commission expiration date, and method of notarization (physical presence or online).
This mandatory affidavit is one of three required attestations that all contractors must complete and submit prior to award of the janitorial services contract, along with the Common Carrier Attestation and Foreign Countries of Concern Affidavit. The Human Trafficking Affidavit serves as a compliance document ensuring that contractor labor practices meet Florida statutory requirements and represent a prerequisite to contract execution. All contractors responding to RFP 26-0234-RFP, regardless of firm size or classification, must execute and notarize this affidavit as part of their proposal submission to be considered for award.
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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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