Human_Trafficking_Affidavit_11.20.25.pdf
PDF 115 KB Posted
- Solicitation number
- 26-0732-RFP
- Issued by
- Pinellas County, 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 serves as a compliance document for contractors bidding on or executing contracts with Pinellas County. The form 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 Florida law. The affidavit must be notarized, with the notary public certifying the contractor representative's identity either through physical presence or online notarization. The document includes fields for the contractor's name, the specific Pinellas County contract number and name, the Federal Work Authorization User Identification Number, and standard notarization information including the notary's commission expiration date.
This affidavit is a mandatory submission requirement for the Artificial Intelligence (AI) Strategic Roadmap and Governance Framework Consultant opportunity with Pinellas County. All prospective bidders must complete and submit this executed and notarized affidavit as part of their proposal package to demonstrate compliance with Florida's human trafficking statutes and Pinellas County's procurement requirements. The affidavit does not establish pricing terms or project funding but rather serves as a legal attestation of the contractor's adherence to labor standards and eligibility to conduct business with the 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 |
File details come from the government source that posted it. Updated .