Human_Trafficking_Affidavit_11.20.25.pdf

PDF 115 KB Posted

Attached to
Janitorial Services for Construction and Property Management Facilities
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, to be completed by contractors bidding on Janitorial Services for Construction and Property Management Department facilities (RFP 26-0234-RFP). The affidavit requires an authorized contractor representative to attest under penalties of perjury that the Contractor does not use coercion for labor or services as defined in Florida law. The form must be notarized by a Florida notary public and includes fields for the contractor's name, Federal Work Authorization User Identification number, contract name and number, the individual's signature and printed name, date of execution, and notary information including seal, commission expiration date, and identification verification method. Proposals for the janitorial services contract are due March 17, 2026, at 3:00 p.m., with a question submission deadline of March 12, 2026, at 2:00 p.m. The initial contract term is 36 months from the award date with two optional 12-month renewal periods available at the County's discretion.

The affidavit is one of three mandatory attestations required prior to contract award, alongside the Common Carrier Attestation and Foreign Countries of Concern Affidavit. The previous janitorial services contract was awarded to High Sources Inc. under Contract Number 23-0230-ITB with a three-year term and total contract value of $5,556,534.84, representing approximately $1,852,178.28 annually. The new contract is budgeted within the CPM Department Operating Budget with FY26 allocations of $2,598,160.00 for contractual services and operating supplies, and will be programmed into CPM's FY27 budget submission. Pricing is submitted through the OpenGov electronic platform using unit costs and monthly rates, with annual price adjustments permitted up to the lesser of the Consumer Price Index or 5%. The procurement does not specify set-aside designations or restrictions limiting response by disadvantaged enterprises.

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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 .