Human_Trafficking_Affidavit_11.20.25.pdf
PDF 115 KB Posted
- Attached to
- Veterinary Drugs and Supplies
- Solicitation number
- 26-0718-ITB
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This is a Human Trafficking Affidavit required by Pinellas County, Florida, in accordance with Section 787.06 of the Florida Statutes, related to a Veterinary Drugs and Supplies contract opportunity. The affidavit serves as a certification document that must be completed and notarized by an authorized representative of the contracting vendor. The form requires the contractor to attest under penalties of perjury that the company does not use coercion for labor or services as defined under Florida law. The document includes fields for the contractor's name, the authorized representative's signature and printed name, the date of execution, Federal Work Authorization User Identification Number, and the specific Pinellas County contract name and number.
The affidavit must be notarized, with the notary public required to acknowledge the document either through physical presence or online notarization. The notary must verify the identity of the signatory and affix their seal, signature, printed name, and commission expiration date to the document. This certification is a mandatory compliance requirement for vendors seeking to do business with Pinellas County and must be submitted as part of the contract award process for the veterinary drugs and supplies procurement.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Veterinary_Drugs_and_Supplies.pdf | ||
| 26-0718-ITB_Pricing_Proposal.xlsx | XLSX spreadsheet | |
| 26-0718-ITB_-_Vendor_References.pdf | ||
| Common_Carrier_Attestation_02.05.2025.pdf | ||
| Foreign_Countries_of_Concern_Affidavit_12.11.2025.pdf |
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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 .