Human_Trafficking_Affidavit_11.20.25.pdf
PDF 115 KB Posted
- Attached to
- Digital Evidence Request for Information
- Solicitation number
- 26-0795-RFI
- 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 of the Florida Statutes. The affidavit must be executed by an authorized representative of any contractor seeking to do business with Pinellas County and serves as a contractual requirement related to the Digital Evidence Request for Information issued by the county. The affidavit requires the contractor to attest under penalties of perjury that the company does not use coercion for labor or services as defined by Florida law. The document must include the contractor's name, contract number, the authorized representative's signature and printed name, the date of execution, and the Federal Work Authorization User Identification Number.
The affidavit must be notarized before submission, with the notary public providing their commission expiration date, seal, and confirmation of the signatory's identity through either physical presence or online notarization. This form appears to be a standard compliance document for county procurement rather than a standalone solicitation, functioning as a prerequisite attestation that contractors must provide as part of their qualification to participate in county contracting opportunities. No specific pricing, renewal terms, or project timeline information is contained within the affidavit itself, as it serves solely as a certification of the contractor's labor practices compliance.
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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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