Human_Trafficking_Affidavit_11.20.25.pdf
PDF 115 KB Posted
- Attached to
- Fire Protection System Inspections and Repair
- Solicitation number
- 26-0261-ITB
- Issued by
- Pinellas County, Florida
About this file
Human Trafficking Affidavit for Fire Protection System Inspections and Repair
This is a Human Trafficking Affidavit required by Pinellas County, Florida for the Fire Protection System Inspections and Repair procurement. The affidavit serves as a mandatory certification document that contractors must complete and submit as part of their bid package. Contractors are required to attest, under penalties of perjury, that they do not use coercion for labor or services as defined in Section 787.06 of the Florida Statutes. The document must be executed by an authorized representative of the contractor and notarized. The affidavit requires completion of standard fields including the contractor name, authorized representative signature and printed name, execution date, Federal Work Authorization User Identification Number, the Pinellas County contract name and contract number, and notary public acknowledgment with commission expiration date.
The affidavit is a compliance requirement within the solicitation for fire protection system services and reflects Pinellas County's commitment to human trafficking prevention in state and local contracting. Submission of this notarized affidavit is a prerequisite for bid consideration. The document includes checkboxes and blank fields for both the contractor representative and the notary public to complete, ensuring proper documentation of the attestation and verification process. This requirement applies uniformly to all bidders responding to the county's fire protection services ITB.
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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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