Human_Trafficking_Affidavit_11.20.25.pdf
PDF 115 KB Posted
- Solicitation number
- 27-0092-RFP
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This document is a Human Trafficking Affidavit 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 the County's 27-0092-RFP for Deferred Compensation Plan Recordkeeping and Administration Services. The affidavit requires an authorized representative of the contracting entity to attest under penalties of perjury that the Contractor does not use coercion for labor or services as defined in Florida Statutes Section 787.06. The form includes spaces for the contractor's representative to sign and print their name, provide their Federal Work Authorization User Identification Number, and identify the specific Pinellas County contract and contract number. The affidavit must be notarized, with the notary public providing their seal, commission expiration date, and confirmation of the signatory's identity through either physical presence or online notarization.
This Human Trafficking Affidavit is a mandatory compliance requirement for any entity seeking to contract with Pinellas County for the deferred compensation plan consolidation project, which involves managing approximately $216 million in plan assets currently held by four providers (Empower, Corebridge, Nationwide, and MissionSquare). The affidavit does not contain pricing information, set-asides, or other financial terms; rather, it is a legal certification document establishing that the contractor maintains ethical labor practices and complies with Florida's human trafficking and labor coercion statutes as a condition of contract eligibility.
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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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