Human_Trafficking_Affidavit_11.20.25.pdf
PDF 115 KB Posted
- Attached to
- Artificial Reef - Tire Removal Project State and local contract opportunity
- Solicitation number
- 26-0349-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 the Artificial Reef - Tire Removal Project. The affidavit requires an authorized representative of the contracting company 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 includes fields for the contractor's name, Federal Work Authorization User Identification number, Pinellas County contract name and number, the authorized representative's signature and printed name, date of execution, and notary acknowledgment information. The notarization can be completed through either physical presence or online notarization.
This affidavit is one of several mandatory compliance documents required from all bidders on the Pinellas County tire removal RFP, alongside the Common Carrier Attestation, Foreign Countries of Concern Affidavit, and E-Verify system registration. Contractors must submit the completed and notarized Human Trafficking Affidavit as part of their proposal package due electronically by April 16, 2026 at 3:00 p.m. through the OpenGov procurement website. This certification requirement ensures contractor compliance with Florida labor trafficking prevention statutes and is a prerequisite for contract award and execution under the twelve-month contract term with one optional twelve-month renewal period.
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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 .