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 for contractors participating in the Rapid Rehousing (RRH) Program solicitation (26-0449-RFP). The affidavit certifies that the contractor does not use coercion for labor or services as defined under Section 787.06 of the Florida Statutes. The form requires completion and notarization by an authorized representative of the contractor and must be submitted as part of mandatory compliance requirements for proposal submission. The RFP seeks qualified organizations to fill two coordinated roles: a Rapid Rehousing Service Provider responsible for direct client engagement, housing navigation, case management, and service coordination for homeless households in Pinellas County, and a Rapid Rehousing Fiscal Administrator responsible for managing and dispersing financial assistance. The program targets a minimum of 60 households annually with estimated service capacity of 85–100 homeless families and individuals. The proposal deadline is April 21, 2026, at 3:00 p.m. via the OpenGov procurement portal, with questions due by April 7, 2026, at 10:00 a.m. No site visits or pre-bid conferences are scheduled. The initial contract term is thirty-six months from award with options for two additional twelve-month renewal periods if all parties agree and pricing remains unchanged.
Pinellas County has allocated a total budget of $1,340,000 for the RRH Program, consisting of up to $600,000 for direct client financial assistance and approximately $740,000 for program operations, with approximately $588,600 designated for the service provider and $155,250 for the fiscal administrator. The contract is funded on a cost-reimbursement basis for actual, allowable, and allocable costs. Successful contractors must process fiscal payments within three to five business days of receiving complete documentation and maintain 95 percent of eligible payment issuance within required timeframes. The fiscal administrator will manage approximately $90,000 in average monthly expenditures while processing payments for approximately 45 households per month with average assistance of $2,000 per household monthly. All responding organizations must comply with mandatory requirements including notarized affidavits, Foreign Country of Concern declarations, E-Verify enrollment, and specified insurance coverage, and must maintain continuity of operations plans with annual reviews and retain all records for five years after final payment.
View the file
Other files
Show 40 more
50 files listed here. See the rest on GovTribe.
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .