10-Attachment C-Human Trafficking.pdf
PDF 333 KB Posted
- Attached to
- 1st Floor Pharmacy Renovation
- Solicitation number
- PROJ-25-098
- Issued by
- Volusia County, Florida
About this file
This is a Human Trafficking Attestation form required by Halifax Health, a healthcare organization in Florida, for any nongovernmental entity executing, renewing, or extending contracts with the health system. The document is designated as Attachment C and is mandated pursuant to Florida Statutes Section 787.06(13), requiring completion by an authorized officer or representative of contracting organizations. The form serves as a compliance mechanism under penalty of perjury and includes fields for the nongovernmental entity's name, authorized signature, printed name, and title of the signing official.
The attestation requires the contracting entity to certify that it does not use coercion for labor or services as defined in Florida Statutes Section 787.06, and establishes ongoing compliance obligations where the entity must immediately notify Halifax Health if the attestation becomes untrue at any time during the contract relationship. The form stipulates that false attestations will result in contract termination and prohibition from entering future contracts with Halifax Health, including renewals or extensions of existing agreements. This standardized form, dated July 2024, represents Halifax Health's compliance framework for human trafficking prevention requirements under Florida state law.
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Text version
Human Trafficking Attestation
Pursuant to Florida Statutes Section 787.06(13), this attestation must be completed by an officer or representative of any nongovernmental entity that is executing, renewing, or extending a contract with Halifax Health.
The undersigned, as an authorized representative or officer of, and on behalf of, the “Nongovernmental Entity,” by executing below, attests, under penalty of perjury, to the following:
The Nongovernmental Entity does not use coercion for labor or services as such italicized terms are defined in Florida Statutes Section 787.06, as the same may be amended from time to time.
The undersigned understands that the statements made herein are made for the benefit of Halifax Health, and its compliance with Florida Statutes Section 787.06, and if at any time the attestation made herein is untrue, the Nongovernmental Entity will immediately notify Halifax Health of same and will not, thereafter, enter into any future contracts with Halifax Health, and will not renew or extend any existing contracts.
Nongovernmental Entity Name:__________________________________________________________
Signature: ____________________________________________________________________
Printed Name: ________________________________________________________________________
Title: _______________________________________________________________________
s. 787.06, FS July 2024
Attachment C
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