Human_Trafficking_Affidavit_-FOR_EXAMPLE_ONLY.pdf
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- Solicitation number
- 26-0494-RFQ-CCNAC
- Issued by
- Pinellas County, Florida
About this file
Human Trafficking Affidavit and MEP Professional Engineering Services RFQ
This is a Human Trafficking Affidavit form template issued by Pinellas County, Florida, in conjunction with a competitive Request for Qualifications (RFQ #26-0494-RFQ-CCNAC) for Mechanical, Electrical and Plumbing (MEP) Professional Engineering Services conducted under Florida Statutes Section 287.055. The county seeks a qualified professional engineering firm to provide on-demand MEP consulting services on an assignment-by-assignment basis, including design activities, plan reviews, engineering calculations, and project support services. Written questions are due by May 12, 2026 at 3:00 PM Eastern Time, with all proposal submittals required by May 21, 2026 at 3:00 PM Eastern Time via the OpenGov Procurement platform. No site visit or pre-bidder conference is required. The initial contract term is five years from execution date with one optional 24-month extension available at the County's discretion subject to rate renegotiation.
Proposers must submit notarized affidavits attesting compliance with Florida Statutes Section 787.06, certifying that the contractor does not use coercion for labor or services. The affidavit requires an authorized representative's signature, notarization with specified state and county information, and a Federal Work Authorization User Identification Number. Evaluation will allocate 1,000 points across six criteria: firm ability and qualifications (425 points), experience with similar projects (375 points), volume of work previously awarded (50 points), minority business status (25 points), Pinellas County Small Business Enterprise certification (100 points), and office location (25 points). Compensation will be based on a fully burdened hourly rate fee schedule negotiated upon award. A set-aside requirement mandates that individual work assignments valued at $50,000 or greater must allocate at least 10 percent of financial commitment to certified Pinellas County small business enterprise subconsultants, unless the prime firm itself is an SBE. Proposers must maintain Commercial General Liability insurance of at least $1,000,000 per occurrence and $2,000,000 aggregate, plus Professional Liability insurance of $1,000,000 per occurrence and aggregate, with Pinellas County named as additional insured. All insurance must be issued by companies authorized in Florida with AM Best ratings of A-VIII or better.
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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 |
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