2-Attachment C-Human Trafficking.pdf
PDF 333 KB Posted
- Attached to
- History Wall
- Solicitation number
- PROJ-26-079
- Issued by
- Volusia County, Florida
About this file
This is a Human Trafficking Attestation form required by Halifax Health, a Florida-based government health entity, for any nongovernmental entity executing, renewing, or extending a contract with the organization. The attestation pertains to a contract opportunity for concept development, design, fabrication, and installation of a museum-quality static history wall commemorating Halifax Health's 100-year anniversary. The form must be completed and signed by an authorized representative or officer of the nongovernmental entity seeking to contract with Halifax Health.
The attestation requires the nongovernmental entity to certify, under penalty of perjury, that it does not use coercion for labor or services as defined in Florida Statutes Section 787.06. The signatory acknowledges that the statements are made for Halifax Health's compliance purposes and agrees that any future misrepresentation of this attestation will result in immediate notification to Halifax Health and disqualification from entering into, renewing, or extending any future contracts with the organization. The form requires the vendor to provide the nongovernmental entity name, signature, printed name, and title of the authorized representative.
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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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File details come from the government source that posted it. Updated .