Human_Trafficking_Affidavit_11.20.25.pdf

This is a Human Trafficking Affidavit form required by Pinellas County, Florida, in connection with the county's Request for Proposal (RFP 26-0292-RFP) for indigent burial and cremation services. The affidavit requires an authorized representative of the contracting entity to attest under penalties of perjury that the contractor does not use coercion for labor or services as defined in Section 787.06 of the Florida Statutes. The form must be notarized and include the signatory's printed name, signature, date, and Federal Work Authorization User Identification Number, along with the name and number of the Pinellas County contract. The notary acknowledgment section requires certification of the method of acknowledgment (physical presence or online notarization), the date of notarization, the contractor's entity type, notary identification information, and the notary's commission expiration date.

As a compliance requirement for the indigent burial and cremation services procurement, all qualified bidders must execute and submit this affidavit along with additional required documentation including a Foreign Countries of Concern Affidavit, Common Carrier Attestation, and a HIPAA Business Associate Agreement. The affidavit serves as a mandatory certification ensuring contractor compliance with Florida labor trafficking statutes and represents a standard compliance mechanism in the county's procurement process for this five-year contract term valued at approximately $550,000 annually with pricing capped at $30,000 per year.