Human_Trafficking_Affidavit_11.20.25.pdf
PDF 115 KB Posted
- Attached to
- Indigent Burial and Cremation Services
- Solicitation number
- 26-0292-RFP
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This is a Human Trafficking Affidavit document required by Pinellas County, Florida for the Indigent Burial and Cremation Services RFP (26-0292-RFP). The affidavit requires contractors to attest under penalty of perjury that they do not use coercion for labor or services as defined in Florida Statutes Section 787.06(14). The document must be executed by an authorized representative of the contracting entity and notarized before a Florida notary public. The affidavit form includes fields for the contractor's name, the authorized representative's signature and printed name, date of execution, Federal Work Authorization User Identification Number, and notarization details including the notary's commission expiration date. This compliance document is a mandatory submission requirement for all bidders competing for the five-year indigent burial and cremation services contract with Pinellas County, with proposals due April 14, 2026, at 3:00 PM.
As a compliance affidavit rather than a pricing or scope document, this form does not contain pricing terms, set-asides, or funding information. Instead, it functions as a prerequisite certification that all qualified bidders must submit alongside their proposals to demonstrate compliance with Florida's human trafficking statutes. The affidavit must be completed and notarized as part of the overall proposal package, ensuring that contractors affirm their adherence to labor law requirements before consideration for the contract 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 |
File details come from the government source that posted it. Updated .