Human_Trafficking_Affidavit_11.20.25.pdf
PDF 115 KB Posted
- Solicitation number
- 26-0234-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, for use in conjunction with the Janitorial Services for Construction and Property Management Facilities contract opportunity. The affidavit serves as a mandatory attestation by an authorized contractor representative that the contracting company does not use coercion for labor or services as defined under Florida law. The document requires the contractor to provide identification information, including the Federal Work Authorization User Identification Number, and must be executed under penalty of perjury with the signatory's printed name, signature, and date clearly documented.
The affidavit must be notarized before a Florida notary public who will verify the contractor's identity through either physical presence or online notarization. The notary must complete all required fields including the state and county where the acknowledgment occurs, the date of notarization, the notary's seal, commission expiration date, and printed or stamped name. The completed form must reference the specific Pinellas County contract name and number to which it applies. This affidavit is a compliance requirement intended to ensure that all contractors performing services for Pinellas County maintain ethical labor practices and adhere to Florida's human trafficking prevention statutes.
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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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