Human_Trafficking_Affidavit_11.20.25.pdf
PDF 115 KB Posted
- Solicitation number
- 26-0234-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 janitorial services for Construction and Property Management Department facilities under RFP 26-0234-RFP. The affidavit requires an authorized contractor representative to attest under penalties of perjury that the contractor does not use coercion for labor or services as defined in Section 787.06, Florida Statutes. The document must be notarized before contract award, with the notary public certifying the acknowledgment through either physical presence or online notarization. The form includes fields for the contractor's name, Federal Work Authorization User Identification number, the Pinellas County contract name and number, the signatory's printed name and signature, the date of execution, the notary's commission expiration date, and identification type produced.
This affidavit is one of three mandatory attestations required from all contractors responding to the janitorial services RFP, along with the Common Carrier Attestation and Foreign Countries of Concern Affidavit. The human trafficking affidavit serves as a compliance mechanism to ensure contractors meet Florida Statutes requirements regarding labor practices and are in good standing prior to contract award. All supporting documentation must be submitted notarized and under penalty of perjury, with the form providing standardized fields to capture contractor identification, authorization details, and notary certification to facilitate processing and verification by Pinellas County.
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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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