Human_Trafficking_Affidavit_11.20.25.pdf
PDF 115 KB Posted
- Attached to
- Window Cleaning Services
- Solicitation number
- 26-0314-ITB
- Issued by
- Pinellas County, Clewiston City, 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, for the Window Cleaning Services contract opportunity. The affidavit requires an authorized representative of the contractor to attest that the contractor does not use coercion for labor or services as defined in Section 787.06 of the Florida Statutes. The document must be signed under penalty of perjury by the authorized representative and notarized before a Florida notary public. Required information includes the contractor's name, Federal Work Authorization User Identification Number, the Pinellas County contract name and contract number, the date of execution, the notary's information, and the notary's commission expiration date.
This affidavit serves as a compliance certification document that contractors must execute and submit as part of the procurement process for the Window Cleaning Services contract with Pinellas County. The document requires notarization and verification of the signatory's identity to ensure the authenticity of the attestation regarding human trafficking compliance. No pricing information, renewal terms, or other contract-specific details are addressed in this affidavit, as it functions solely as a prerequisite compliance document that demonstrates the contractor's commitment to adhering to Florida's human trafficking statutes and regulations.
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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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