Human_Trafficking_Affidavit_11.20.25.pdf
PDF 115 KB Posted
- Attached to
- Executive Search Services
- Solicitation number
- 26-0276-RFP
- Issued by
- Pinellas County, Florida
About this file
This is a Human Trafficking Affidavit form required by Pinellas County, Florida for contractors bidding on an executive search services contract. The affidavit serves as a statutory compliance document pursuant to Florida Statutes Section 787.06(14), wherein the contractor's authorized representative attests under penalty of perjury that the contractor does not use coercion for labor or services. The form requires completion by an authorized company representative and must be notarized before a notary public. The affidavit includes fields for the contractor's name, the signatory's printed name and signature, the notary's information and commission expiration date, the Federal Work Authorization User Identification Number, and the specific Pinellas County contract name and number. The document establishes a mandatory compliance requirement for all bidders responding to Pinellas County's Request for Proposal for executive search services, which has a proposal submission deadline of April 14, 2026 at 3:00 PM via the OpenGov procurement portal.
The affidavit represents one of several mandatory compliance certifications required by Pinellas County as part of its procurement process, alongside Common Carrier Attestation, Foreign Country of Concern Affidavit, and proof of E-Verify compliance. Contractors must execute and submit this human trafficking attestation as a prerequisite to contract award for the 12-month initial term with two optional 12-month renewal periods. The notarization requirement ensures verification of the signatory's authority and identity, protecting both the County and the contractor by creating an official record of the compliance declaration. This form is a standard protective measure for government contracting in Florida and does not contain pricing information or budget allocation details.
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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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