Human_Trafficking_Affidavit.pdf
PDF 89 KB Posted
- Solicitation number
- 26-0510-RFQ-CCNA
- Issued by
- Pinellas County, Clewiston City, Florida
About this file
This is a Human Trafficking Affidavit required by Section 787.06 of the Florida Statutes for contractors engaging with Pinellas County on the 54th Avenue N Roadway Improvements project (PID 003882A). The affidavit requires an authorized representative of the contracting entity to attest under penalty of perjury that the contractor does not use coercion for labor or services as defined in Florida law. The document must be notarized, with the notary public certifying the affiant's identity and the date of acknowledgment, whether by physical presence or online notarization. The affidavit includes fields for the contractor's name, the specific Pinellas County contract and contract number, the affiant's signature and printed name, and Federal Work Authorization User Identification Number.
This affidavit serves as a compliance certification mechanism for Pinellas County to ensure that contractors meet human trafficking prevention requirements under Florida statute. The document does not specify pricing terms, funding sources, project timelines, or contract performance details, as it functions solely as a prerequisite attestation. All contractors bidding on or executing work for Pinellas County contracts must complete and submit this notarized affidavit as part of their contractual obligations.
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Text version
HUMAN TRAFFICKING AFFIDAVIT
In accordance with section 787.06 (13), 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 .