Human_Trafficking_Affidavit_11.20.25.pdf
PDF 115 KB Posted
- Attached to
- 26-0449-RFP Rapid Rehousing Fiscal Administration & Service Provider Collaborative Program
- Solicitation number
- 26-0449-REQ
- 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 of the Florida Statutes for the Rapid Rehousing Fiscal Administration & Service Provider Collaborative Program (RFP 26-0449-RFP). The affidavit serves as a mandatory compliance document that contractors must complete and have notarized to attest that they do not use coercion for labor or services. The form requires an authorized representative of the contractor to declare under penalties of perjury that the contractor complies with Florida's human trafficking statutes. The document must be accompanied by notarization through either physical presence or online notarization, and includes fields for the contractor's name, Federal Work Authorization User Identification Number, Pinellas County contract name and number, notary information, and the notary's commission expiration date. This affidavit is one of several mandatory compliance requirements that responding organizations must submit with their proposals, alongside Common Carrier Attestations, Foreign Country of Concern Affidavits, and proof of E-Verify registration.
The affidavit form contains no pricing information, set-asides, or funding details, as it is purely an attestation document. All organizations responding to RFP 26-0449-RFP must complete and submit a notarized copy of this affidavit as a condition of proposal eligibility. The form is a standard compliance requirement with no exceptions or modifications permitted, reflecting Pinellas County's commitment to ensuring contractors maintain ethical labor practices and comply with state human trafficking prevention statutes.
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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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