Human_Trafficking_Affidavit_11.20.25.pdf
PDF 115 KB Posted
- Solicitation number
- 26-0739-RFP
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This is a Human Trafficking Affidavit form required by Pinellas County, Florida, in accordance with Section 787.06(14) of the Florida Statutes. The affidavit applies to the HVAC System Repairs, Replacements, and Technical Support contract opportunity and requires contractors to attest under penalties of perjury that they do not use coercion for labor or services as defined in Florida law. The form must be executed by an authorized representative of the contractor and notarized before a Florida notary public, with the affidavit including the contractor's name, contract number, Federal Work Authorization User Identification Number, and relevant dates. The document serves as a compliance certification ensuring that all contractors engaged by Pinellas County meet state-mandated human trafficking prevention standards.
The affidavit is a mandatory submission requirement for contractors bidding on or executing county contracts. Contractors must provide complete information including their Federal Work Authorization User Identification Number and details of the specific Pinellas County contract for which they are applying. Notarization must be performed by a Florida notary public who verifies the contractor representative's identity through either physical presence or online notarization. The form does not establish pricing terms, set-asides, or funding information but rather functions as a prerequisite compliance document that all contractors must complete and submit as part of their contract proposal or execution process.
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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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