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 form required by Pinellas County, Florida for contractors bidding on indigent burial and cremation services under RFP 26-0292-RFP. The affidavit requires an authorized representative of the bidding contractor to attest under penalty 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 include the contractor's name, the notary's seal and information, and the Federal Work Authorization User Identification Number. The affidavit is a mandatory compliance document that must be submitted with the proposal by the April 14, 2026 deadline at 3:00 PM via the OpenGov procurement website.
This affidavit is one of multiple required compliance documents for the solicitation, alongside a Foreign Countries of Concern Affidavit, a Common Carrier Attestation, and a HIPAA Business Associate Agreement. Contractors must also demonstrate current Florida funeral director licensure, maintain an FDEP-certified incinerator facility with minimum refrigerated storage for 100 concurrent bodies, and carry commercial general liability insurance of $1,000,000 and professional liability insurance of $1,000,000. The contract is valued at a maximum annual bid of $30,000 with an estimated annual funding not to exceed $550,000, and the contract term is five years from the date of award with no current incumbent vendor identified.
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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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