Human_Trafficking_Affidavit_11.20.25.pdf

This Human Trafficking Affidavit is a required certification document for Pinellas County, Florida's RFP 26-0137 for Workers Compensation Third-Party Administrator Services. The affidavit requires an authorized representative of the contractor 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 document must be notarized and includes fields for the contractor's name, the authorized representative's signature and printed name, the Federal Work Authorization User Identification Number, the notary's information and commission expiration date, and the specific Pinellas County contract name and number. The affidavit serves as a compliance certification that must be executed and submitted as part of the proposal process for this workers compensation TPA procurement.

The affidavit is a mandatory compliance requirement for all bidders responding to the RFP 26-0137 procurement, which seeks to transition Pinellas County's approximately 5,359-employee workers compensation program from self-administration to a third-party administrator model. Qualified vendors must be Florida-licensed TPA providers with a minimum of seven years' experience administering workers' compensation claims for municipalities. Proposals are due January 22, 2026, at 3:00 p.m. through the OpenGov procurement portal, with the initial contract term spanning three years and two optional one-year renewal periods. No specific set-aside designations or budget ranges are explicitly stated in the available documentation.